A partir da experiência clínica com pacientes em UTI, foi realizada uma pesquisa que teve como objetivo compreender a experiência subjetiva destes, considerando o ser humano como ser biopsicossocial, levando em conta não só a enfermidade orgânica ou suas condições clínicas, mas também seus aspectos psicológicos, sua história, percepções, angústias, medos e fantasias. Os participantes selecionados tinham mais de 18 anos de idade, estavam aptos para se comunicar adequadamente - sem o impedimento de lesões ou equipamentos - e, segundo a equipe de enfermagem, possuíam condições clínicas que permitiam a participação no estudo. O método de pesquisa foi o clínico-qualitativo e, dessa forma, a coleta de dados foi realizada a partir de entrevistas semi-dirigidas, com tempo médio de trinta minutos, que aconteceram no leito de UTI, preservando a postura psicanalítica de escuta e acolhimento. Antes de sua realização, foi utilizada a escala mini-mental para verificar o nível de consciência. As entrevistas foram transcritas e a partir da leitura destas, emergiram algumas categorias, que foram analisadas. A análise das entrevistas revelou uma percepção ambivalente da UTI. Ao mesmo tempo em que é um local de elevada sofisticação tecnológica, o que lhes transmite segurança, é também um espaço de contato com suas próprias limitações. A análise revelou ainda ser este, um momento de dificuldade para muitos dos pacientes, por conta da existência de feridas narcísicas, vivência de castração, desamparo, distância da família, angústia de morte, entre outros. Tal momento, no entanto, dependendo de suas crenças ou histórias de vida, além de difícil, é também comumente visto por eles como um período de reflexão sobre sua existência e até mesmo de amadurecimento / From clinical experience with ICU patients, a survey was conducted aiming to understand their subjective experience, considering the human being as a biopsychosocial being, taking into account not only the organic disease or clinical conditions, but also his psychological aspects, history, perceptions, anxieties, fears and fantasies. The selected participants were 18 or more years old and able to communicate properly - without injuries or equipment - and, according to the nursing staff, had medical conditions that allowed the participation in the research. The research method was the clinical-qualitative one, and thus the data collection was obtained by semi-directed interviews with an average of thirty minutes performed in the ICU bed, preserving the psychoanalytic approach of listening and reception. Before its completion, the minimental scale was used to assess the level of consciousness. The interviews were transcribed and from their reading, some categories emerged, that were analyzed. This analysis revealed an ambivalent perception of the ICU. While it is a place of high technological sophistication, which gives safety to them, it is also an area of contact with their own limitations. The analysis also revealed that this is a time of difficulty for many patients because of the existence of narcissistic wounds, experience of castration, helplessness, distance from family, fear of death, among others. This moment, however, depending on their beliefs or life stories, besides difficult, it is also commonly seen by them as a period of reflection on their lives and even on their personal growth

Introdução: Apesar dos recentes estudos, a sepse ainda é uma das mais importantes causas de hospitalização e morte nas Unidades de Terapia Intensiva (UTI). A equipe de enfermagem tem papel primordial no reconhecimento dos sinais e sintomas iniciais e acredita-se que a aferição dos sinais vitais de forma correta e completa, possa ser uma ferramenta simples, de baixo custo e não invasiva, para avaliar a predisposição a um desfecho de alta ou óbito nos pacientes sépticos em UTI. Objetivo: Avaliar a relação dos sinais vitais aferidos pela equipe enfermagem no momento do diagnóstico de sepse, com o desfecho clínico e com os scores MEWS e qSOFA. Métodos: Trata-se de um estudo com delineamento observacional, analítico que utilizou dados de fontes secundárias e o tratamento dos dados com abordagem metodológica quantitativa. Resultados: A média de idade dos pacientes foi de 56,4 anos e a maioria do sexo masculino, 53,4%. As doenças cardiovasculares ocuparam 43,1% das comorbidades existentes. O tempo médio de internação em UTI foi 8,0 dias e de internação hospitalar total de 29,6 dias e os pacientes sobreviventes permaneceram mais tempo internados tanto hospitalar quanto na UTI. A frequência cardíaca variou entre 38 e 162 bpm e foi observado que os pacientes que foram a óbito apresentavam-se mais taquicárdicos do que os sobreviventes. O desfecho de óbito ocupou mais de 70% dos casos analisados e após a aplicação dos escores qSOFA e MEWS não foi observado associação estatisticamente significativa entre eles e o desfecho (p=0,215). Conclusão: A aferição da frequência cardíaca no momento do diagnóstico de sepse pode ser utilizado como ferramenta efetiva, rápida, não invasiva e de baixo custo, para auxiliar no diagnóstico e predição de maior risco de óbito nos pacientes sépticos em UTI / Introduction: Despite recent studies, sepsis is still one of the most important causes of hospitalization and death in Intensive Care Units (ICUs). The nursing team has a primordial role in the recognition of the initial signs and symptoms and it is believed that the correct and complete measurement of the vital signs can be a simple, low-cost and non-invasive tool to evaluate the predisposition to an outcome discharge or death in septic patients in ICU. Objective: To evaluate the relationship of the vital signs measured by the nursing team at the moment of the diagnosis of sepsis, with the clinical outcome and the MEWS and qSOFA scores. Methods: This is a study with an observational, analytical design that used data from secondary sources and the treatment of the data with a quantitative methodological approach. Results: The mean age of the patients was 56.4 years and the majority of the males, 53.4%. Cardiovascular diseases accounted for 43.1% of the existing comorbidities. The mean ICU length of hospital stay was 8.0 days and total hospital stay was 29.6 days, and the surviving patients remained longer hospitalized both in the hospital and in the ICU. The heart rate varied between 38 and 162 bpm and it was observed that patients who died had more tachycardia than the survivors. The outcome of death was more than 70% of the cases analyzed and after the application of the qSOFA and MEWS scores, no statistically significant association between them and the outcome (p = 0.215) was observed. Conclusion: Heart rate measurement at the time of diagnosis of sepsis can be used as an effective, fast, non-invasive and low cost tool to assist in the diagnosis and prediction of a higher risk of death in septic patients in ICU

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk for complications such as ventilator associated pneumonia, thromboembolisms, and pressure ulcers. The purpose of this evidence-based practice (EBP) quality improvement project was to evaluate an EPM program based to improve interdisciplinary collaboration and care coordination. The introduction, development, and evaluation of this project were guided by the Iowa Model and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) bundle. The EPM program was implemented in a 20-bed ICU in a 400-bed hospital as the Mobilization Criteria / Algorithm for Critical Care Patients (MCACCP). Retrospective data was collected for six months from the electronic health record and evaluated with a web-based analytics tool. The project resulted in a 1.2-day decrease in ICU LOS and a 6.7% reduction in ventilator days. The average daily census decreased from 16.2 in 2015 to 14.7 through 2016. EBP research supports the benefit of early mobility of ICU patients to reduce complications, ventilator days, LOS, and the overall cost for care. This project demonstrates standardizing clinical practice based on EBP guidelines and protocols translates into improved teamwork, patient outcomes, and organization metrics.

acase@tulane.edu

Abstract not available

Royal Perth Hospital is the largest hospital in Western Australia and also has the largest intensive care unit (ICU) in the State. It was the first public hospital to provide intensive care services in Western Australia. This thesis examines the intermediateand long-term outcomes of patients admitted to the Royal Perth Hospital ICU between 1987 and 2002. Intermediate-term survival, defined as survival after discharge from hospital to one year and long-term survival, that exceeding one year after discharge, are important outcomes. Information on outcomes can be used by ICU staff in discussions with patients and their families and to inform policy decision-making and future research. The aim of this research was to examine one-year and long-term outcomes of patients admitted to the ICU between 1987 and 2002 and explore the factors that might be associated with the outcomes for 22,298 patients admitted to the ICU. A clinical ICU database was linked to morbidity and mortality databases by Data Linkage WA. A wide range of demographic and clinical factors were examined for their effect on outcome. These included age, sex, comorbidity, severity of illness, organ failure, ICU diagnostic groups, type of admission (medical, elective surgical and non-elective surgical), length of stay in ICU and era of admission (1987-1990, 1991-1994, 1995-1998, 1999-2002). Patients were followed-up to study end, 31st December 2003 or death if it occurred before study end, that is, up to 17 years after the index ICU admission. Kaplan Meier survival curves and Cox regression models were used to examine intermediate and long-term survival for patients who survived to hospital discharge. A comparison of admissions to hospital before and after the index ICU admission was made using descriptive statistics and logistic regression. Throughout the study period survival for the ICU cohort was shorter when compared to the Australian population. This was consistent throughout the follow-up period. The most important determinants of long-term survival were age, comorbidity, severity of illness and diagnostic group but the strength of association varied with the duration of follow-up. Although age, comorbidity and severity of illness increased among the critically ill survival improved over time. Hospital admissions were more frequent after a discharge from hospital that required an admission to ICU than before the index admission, even after adjusting for the ageing of the cohort. This study provides unique information about the survival and other outcomes of patients discharged from a hospital admission that included an ICU stay. The strength of this study lies in the follow-up to 17 years and the more comprehensive range of explanatory factors than in previous studies. This thesis demonstrates that follow-up studies after intensive care should be of sufficient duration to account for the changes that occur in survival over time and indicates the range of factors that should be taken into account when making comparisons of long-term survival.

Background: Comprehensive oral care is an evidence-based, cost effective, essential routine nursing intervention that nurses ought to provide with good knowledge/understanding as it prevents and controls nosocomial infections especially Ventilator Associated Pneumonia (VAP) that is associated with increased morbidity and mortality in critically ill patients in Intensive Care Units (ICU). Aim of study: To determine ICU nurses’ knowledge, describe their practices and identify their perceptions regarding comprehensive oral health care to critically ill patients in order to refine or develop evidence based oral care protocol. Methods: A quantitative approach with a descriptive, exploratory survey was used for this study. A non probability convenience sample of thirty-four (34) ICU nurses from two public referral hospitals participated in this study. A questionnaire with a combination of open and closed ended questions was used to collect data on comprehensive oral care to critically ill patients. Results Thirty-four nurses responded to the questionnaire (response rate 89%). Only 18% (n=6) were knowledgeable about important aspects of oral care, while the majority, 82% (n=28) lacked knowledge on important aspects of oral care. Fifty-nine percent (59%) n=20 had received training on comprehensive oral care at basic nursing training and 44% (n=15) had orientation at unit level. Ninety-seven percent (97%) n=33 of the participants requested further updates on comprehensive oral care. No significant relationships were found between nurses’ demographic characteristics and knowledge of comprehensive oral care. All (100%) n=34 of nurses gave oral care a high priority and 91% ranked it very important for critically ill patients. Toothbrushes and toothpaste were used by 85% (n=29) of nurses and only 50% (n=17) used mouthwashes. The reason for non- use of mouthwashes was lack of supplies and not having been foreseen in unit protocol although neither of the units had an oral care protocol in place. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.