Titel: Intensivvårdssjuksköterskors erfarenheter av att bedöma sederade patienter i ventilator: En kvalitativ intervjustudie. Bakgrund: Den kritiskt sjuke intensivvårdspatienten behöver såväl resurskrävande som komplicerad behandling. Sedering administreras till patienter i ventilatorbehandling för att lindra ångest och smärta. Intensivvården bygger på multiprofessionellt samarbete och strävar efter individuellt anpassad sedering för att upprätthålla komfortabel sederingsnivå. Riktlinjer och bedömningsskalor är viktiga hjälpmedel vid bedömning och titrering av sedering. Det är utmaningar i att vårda sederade patienter och det ställer stora krav på intensivvårdssjuksköterskan. Syfte: Syftet var att belysa intensivvårdssjuksköterskors erfarenheter av att bedöma sederade patienter i ventilator på intensivvårdsavdelning. Metod: Studien genomfördes med en kvalitativ design genom individuella semistrukturerade intervjuer med tio intensivvårdssjuksköterskor. Nio av deltagarna var kvinnor och en var man. Data analyserades genom kvalitativ innehållsanalys. Resultat: Studiens resultat frambringade i följande tema Bedömning – En väg av utmaningar som belyste intensivvårdssjuksköterskors erfarenheter av att bedöma sederade patienter i ventilator. Resultatet presenteras under två kategorier: Osäkerhet vid sederingsnivå och Brister vid sedering. Osäkerhet vid sederingsnivå blev påtaglig på grund av otydliga riktlinjer, svårigheter i att upprätthålla en individuell sederingsnivå och utifrån den komplicerade kommunikationen med patienten. Brister vid sedering blev påtaglig på grund av känsla av otillräcklighet och brist på både samarbete och kunskap försvårade ytterligare intensivvårdssjuksköterskans bedömning och titrering av sedering. Slutsats: Studien identifierar utmaningar som bidrar till osäkerhet och brister vid sedering. Dessa utmaningar bör förhindras genom utbildning för att bibehålla patientsäkerheten och möjliggöra god vård. Intensivvårdssjuksköterskan bör få insikt i de samhällsekonomiska vinster som god följsamhet till riktlinjer och bedömningsskalor frambringar.

No description available.

Ventilator-associated pneumonia (VAP) is a serious complication in critically ill patients; it can prolong intubation, increase intensive care unit and hospital length of stay, and increase mortality to twice the level of patients who do not develop VAP. The purpose of this project was to determine the effect of an evidence-based educational program to prevent VAP on ICU nurses' actual and documented practices for preventing VAP. The research questions addressed whether an educational program focused on VAP prevention will affect critical care nurses' compliance with a VAP prevention bundle, and whether the education will result in maintenance of a rate of zero cases of VAP per 1000 ventilator days. Data will be collected from all ICU patients intubated more than 24 hours and will include: (a) the frequency of oral care, (b) head-of-bed elevation of 30-45 degrees, (c) daily sedation vacation, (d) assessment of readiness for extubation, and (e) whether prophylaxis for deep vein thrombosis and for peptic ulcer disease was ordered. Observations of care will verify the accuracy of nurses' documentation in the medical record. A survey will assess nurse satisfaction with the educational program. Paired t tests will be used to compare the compliance of the nurses with each element of oral care and hygiene practices before and after the intervention. Analysis of variance will be calculated on the mean duration of ventilation, mean ICU and hospital length of stay, mortality before discharge, patient acuity, and rates of VAP per 1000 ventilator days. The goal of this project is a compliance rate of 90% or greater with the elements of the VAP prevention bundle, leading to decreased ventilator and ICU days, decreased morbidity, decreased mortality, and lower emotional distress. Positive social change will be accomplished through an immediate improvement in the lives of VAP-prone individuals.

Although mechanical ventilator is a life-saving intervention, longer ventilation time and excessive tidal volume contribute to lung injury and increased incidence of infection which is associated with higher mortality. IL-6, a pleiotropic cytokine, participates in both pro- and anti-inflammatory responses. Till now, opinions of the role of IL-6 are widely divided. To study the pathogenesis mechanism of ventilator-induced lung injury (VILI), C57BL/6 mice (WT), IL-6 knockout mice (IL6-/-), chimera (IL6-/- ¡÷ WT) and deletion of I£eB kinase in the myeloid (IKK¡µmye) mice were placed on ventilator for 6 hr. WT mice were also given the IL-6-blocking antibody just before ventilation to evaluate the role of IL-6 signaling in VILI. The results revealed that the pulmonary capillary permeability, neutrophil sequestration, macrophage drifting and protein concentration in bronchoalveolar lavage fluid, and the proinflammatory cytokine levels were significantly increased in ventilated WT mice but not in those pretreated with IL-6-blocking antibody as well as IL6-/-, IKK¡µmye, and IL6-/- ¡÷ WT chimera mice, suggesting that NF-£eB¡VIL-6 signaling could induce inflammation which contributes to the VILI. Furthermore, the antibacterial ability of alveolar macrophages was impaired by ventilation that subsequently increased the danger of developing to ventilator-associated pneumonia.

According to the report of the Bureau of National Healthcare Insurance (NHI) in 1997, the total expenses on ventilator-dependent patients was about 7,100 million yuan in hospital, account for 3% of the cost of one year of health insurance of the whole people. To efficiently control their admission so as to decrease unsuitable utilization of mechanical ventilation, and to achieve the rational growth of medical expenditure, the NHI has developed the perspective payment system for the ventilator-dependent integrated delivery system (IDS) respiratory care program since July 1, 2000. Ventilator-dependent patients, difficult to wean, rely on the mechanical ventilation, using for at least 21 days in succession. The patients are dependent upon long-term mechanical respiratory care. Integrating the different level of respiratory care, IDS program is including ¡§ICU , intensive care unit¡¨, ¡¨RCC, respiratory care center¡¨, ¡¨ RCW , respiratory care ward¡¨ and ¡§home care¡¨ and pay in accordance with the level. The purpose of IDS program is to promote the quality of respiratory care and effectively to utilize the limited medical resources. The data for this research was retrieved from the 2002-2004 ¡§NHI database¡¨ that includes charge and discharge information for 115 hospitals. Of the 115 hospitals analyzed using data envelopment analysis (DEA) technique, to explore the whole efficiency and purely technological efficiency.

Ventilator-associated pneumonia (VAP) is a serious complication in critically ill patients; it can prolong intubation, increase intensive care unit and hospital length of stay, and increase mortality to twice the level of patients who do not develop VAP. The purpose of this project was to determine the effect of an evidence-based educational program to prevent VAP on ICU nurses' actual and documented practices for preventing VAP. The research questions addressed whether an educational program focused on VAP prevention will affect critical care nurses' compliance with a VAP prevention bundle, and whether the education will result in maintenance of a rate of zero cases of VAP per 1000 ventilator days. Data will be collected from all ICU patients intubated more than 24 hours and will include: (a) the frequency of oral care, (b) head-of-bed elevation of 30â??45 degrees, (c) daily sedation vacation, (d) assessment of readiness for extubation, and (e) whether prophylaxis for deep vein thrombosis and for peptic ulcer disease was ordered. Observations of care will verify the accuracy of nurses' documentation in the medical record. A survey will assess nurse satisfaction with the educational program. Paired t tests will be used to compare the compliance of the nurses with each element of oral care and hygiene practices before and after the intervention. Analysis of variance will be calculated on the mean duration of ventilation, mean ICU and hospital length of stay, mortality before discharge, patient acuity, and rates of VAP per 1000 ventilator days. The goal of this project is a compliance rate of 90% or greater with the elements of the VAP prevention bundle, leading to decreased ventilator and ICU days, decreased morbidity, decreased mortality, and lower emotional distress. Positive social change will be accomplished through an immediate improvement in the lives of VAP-prone individuals.

Pulmonary aspiration in mechanical ventilation occurs despite appropriate inflation of the tracheal tube cuff. After anaesthesiath is can causep ostoperative and, in critically ill patients, ventilator-associated pneumonia. Cuff over-inflation exerts excessive pressure on the tracheal mucosa causing injury. High volume low pressure (HVLP) cuffs permit wall pressure control as the intracuff pressure (CP) is the tracheal wall pressure (TWP). Unfortunately, at the cuff wall, folds and channels and, therefore, fluid leakage occur. Low volume high pressure (LVHP) cuffs develop neither folds nor associated leakage, but TWP is not easily inferred from CP and excessive pressures can result in tracheal injury. This thesis examines the problem of aspiration in a model, in anaesthetised patients and in the critically ill. In the model, protection against leakage resulted from positive end-expiratory pressure and cuff lubrication. Two tracheal cuff prototypes are introduced. Firstly, the compliant HVLP cuff is one with a tapered shape made of highly compliant material. Within the model this produced a circumferential band at the cuff wall without folds thus effectively eliminating channels and leakage. Secondly, the prototype pressure limited cuff (PLC) is a latex LVHP cuff with inflation characteristics such that TWP can be inferred from CP and maintained at an acceptable level. Within the model the PLC prevented leakage at acceptable TWPs. For clinical use a constant pressure inflation device is required to provide uninterrupted protection, although notably HVLP cuffs allow leakage despite this. The PLC prevented dye aspiration in 100% of tracheally intubated critically ill patients compared with 13% of the control HVLP group (p<0.01). A silicone cuff with similar inflation characteristics, yet improved biocompatability and shelf life, prevented dye aspiration in 100% of patients with tracheostomies compared to 0% of the HVLP control group (p=0.001). HVLP cuff lubrication delayed dye aspiration for 1 to 5 days (p<0.05).

Syfte: Syftet med studien var att kartlägga preventiva omvårdnadsåtgärder för att förhindra ventilator-associerad pneumoni på en thoraxintensivvårdsavdelning. Bakgrund: De vanligaste vårdrelaterade infektionerna på intensivvårdsavdelningar är pneumonier och bland dessa är 80 % ventilatorassocierade. Vårdrelaterade infektioner innebär stora kostnader för samhället och ökat vårdlidande för den drabbade patienten. För att förhindra uppkomsten av ventilator-associerad pneumoni (VAP) finns ett antal omvårdnadsåtgärder som har visat sig vara effektiva vad gäller att motverka VAP. Design: Studien är en journalgranskning med retrospektiv deskriptiv design. Metod: Ett klusterurval gjordes där patienter som vårdats minst två påbörjade dygn i respirator valdes ut. Totalt togs 126 journaler fram varav 17 journaler exkluderades och slutligen ingick totalt 109 journaler i studien. Journalerna granskades med hjälp av ett protokoll där följande omvårdnadsåtgärder kontrollerades: tandborstning, munvård med klorhexidinlösning, antal utförda kufftrycksmätningar, registrerat kufftryck, höjd huvudända, subglottisaspiration, sederingsgrad enligt Richmond Agitation Sedation Scale (RASS) samt gurgling med klorhexidinlösning. Datan analyserades i statistikprogrammet SPSS. Resultat: Deltagarna delades in i två grupper utifrån ålder (grupp 1 ≤ 69 år, grupp 2 ≥ 70 år). Munvård med klorhexidin var den åtgärd som utfördes flest gånger per dygn med medianvärde fyra i båda åldersgrupperna. Därefter följde kufftrycksmätning med en median på två kontroller per dygn. Medianvärdet för höjd huvudända var ett i båda grupperna. Tandborstning var den åtgärd som utfördes minst antal gånger. Det var inga signifikanta skillnader mellan de olika åldersgrupperna vad gäller utförda omvårdnadsåtgärder. Konklusion och kliniska implikationer: En rimlig bedömning är att kontinuerlig uppdatering beträffande den senaste forskningen hos vårdpersonal samt revidering av PM kommer att ge bättre vårdresultat, kortare vårdtider, mindre kostnader för samhället och mindre vårdlidande. Resultatet pekar på behov av antingen bättre följsamhet till befintliga rekommendationer, eller noggrannare och tydligare dokumentation av utförda åtgärder.

A test setup was designed and built to test energy recovery ventilator membranes. The purpose of this test setup was to measure the heat transfer and water vapor transfer rates through energy recover ventilator membranes and find their effectiveness, with air conditions that resemble residential use. Two test chambers were constructed with different channel heights above the membrane; one was 1mm and the other 2mm. The 2mm setup gave measureable results, but small air leaks in the system of 7.0% and 6.2% left room for error. The 1mm setup also had air leaks but they were smaller than the 2mm setup, with leak rates of 1.0% and 5.1%. The permeance of the membrane was found to be 2.58x10^-5 g/(m2*s*Pa) for the 2mm test chamber and 9.90x10^-54 g/(m2*s*Pa) for the 1mm test chamber.

The overall aim throughout the project was to outline a new modular platform for a future generation of ventilators as well as designing a ventilator based on the defined platform. Doing so through a conceptual approach, looking at enabling cost efficient development, manufature and product scalability as well as taking the users needs for flexibility, improved usability, cable management and transport into consideration. The project used a traditional user centric design approach while also having a strong manufacturers focus when it came to looking at modularity and the company’s product offering.  The main insights throughout the project revolved around looking at the entire ecosystem of products and how they worked together in the intensive care unit (ICU). Understanding the core struggles and time consuming tasks in order further improve the workflow in the ICU. A big part of the ideation and concept development process was spent on building rough mock-ups for fast evaluation together with users and the collaborating partner. The result was a combined, highly modular, ventilator and monitoring system called Servo One. With a new tubing system that incorporated both humidifier and patient filter in a flexible way, together with an external sensor system, the concept drastically improved cable and tubing management - one of the biggest challenges in the ICU.