No description available.

Introduction: The presence of an endotracheal tube (ETT) increases the risk for microaspiration of secretions around the ETT. Biomarkers of pepsin and salivary amylase may be used to identify microaspiration in intubated patients because of their naturally occurring presence in the stomach or oral cavity and non-occurrence in the respiratory tract. Microaspiration may be difficult to detect until pulmonary complications, such as lung injury or infection, occur. This study assessed the presence of pepsin and salivary amylase in oral and tracheal secretions of ventilated adults. Method(s): This is a secondary analysis of data collected from 11 critically ill, adult patients on mechanical ventilation (MV) enrolled in a study to identify cues for ETT suctioning. Two paired samples of oral and tracheal secretions were suctioned when clinically indicated. Tracheal secretions were suctioned with a closed system, and oral secretions were obtained with an oropharyngeal catheter. Specimens were analyzed for total pepsin, pepsin A, pepsin C, and salivary amylase according to established assays. Results: Of 11 subjects, the majority were men (n=8), on enteral feedings (n=9) via a feeding tube placed in the stomach (n=7), and intubated with a continuous subglottic suction ETT (n=8). Median values: age, 62 years; duration of MV, 5.5 days; ETT cuff pressure 24 cm H2O; head of bed, 30degrees]. Pepsin was in measured in both oral (30.5 ng/mL; n=8) and tracheal secretions (11.1 ng/mL; n=7); Similar findings were noted for pepsin A (oral 14.7 ng/mL, n=7; sputum 7.4 ng/mL, n=6) and pepsin C (oral 14.7, n=7; tracheal 7.4, n=6). Salivary amylase (mean micro]mol/min/mL) was present in all oral secretions (359.8) and in the sputum of 6 subjects (1.8). Discussion & Conclusions: The majority of intubated patients on MV had both pepsin and salivary amylase in their sputum, likely due to microaspiration of secretions.; This finding suggests greater efforts are needed to reduce patients' risk. Ongoing strategies to prevent gastric reflux are important such as head of bed elevation and monitoring residuals. Presence of salivary amylase within tracheal secretions may indicate a need for more frequent oropharyngeal suctioning as part of routine care of intubated patients. Analysis shows no variations of the presence of pepsin or salivary amylase in relation to feeding tube placement or type of ETT. Generalizability is limited by the small sample size.

Inom intensivvård bedrivs omvårdnad i en högteknologisk miljö. Flera av patienterna är i behov av andningshjälp i form av ventilatorbehandling vilket medför att patienten är sederad och har en endotrachealtub i trachea. Patienten kan inte själv utföra sin munvård och blir därför beroende av intensivvårdsjuksköterskans hjälp. Syftet med studien var att belysa intensivvårdssjuksköterskans erfarenhet av munvård av intuberade intensivvårdspatienter. Studien utfördes med en fokusgruppsintervju och analyserades med en kvalitativ innehållsanalys. Kategorierna som framkom i studien var att munvård handlar om prioritering, risker, teamarbete och kommunikation, utförande, patientperspektiv och ansvar. Förslag på fortsatt forskning skulle kunna leda till ett validerat bedömningsinstrument för munvård av intuberad patient samt evidensbaserade riktlinjer för munvård. / Intensive care is conducted in a high technological environment. Many of the patients are in need of breathing assistance with the help of a ventilator, which means that the patient is sedated and intubated. The patients can´t perform their oral care by themselves and therefore dependent on the help of intensive care nurses. The purpose of this study was to elucidate critical care nurses' experiences of oral care in intubated ICU patients. The study was performed with a focus group interview and analyzed by a content analysis. The categories that emerged from the study were that oral care is about priorities, risks, teamwork and communication, performance, patient perspective and responsibility. Suggestions for further research could lead to a validated assessment tool for oral care of intubated patients and evidensbased guidelines for oral care.

Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative.

Bakgrund: Djup sedering har negativa effekter såväl för respiratorvårdade patienter som för verksamheten. Det har medfört att fler patienter vårdas med lätt eller ingen sedering. Mindre sedering har visat sig vara utmanande och ställt högre krav på intensivvårdssjuksköterskor i flera aspekter. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors upplevelser av att vårda intuberade patienter med lätt eller ingen sedering. Metod: En kvalitativ ansats med beskrivande design. Tio intensivvårdssjuksköterskor intervjuades via semistrukturerade intervjuer. Data analyserades med kvalitativ innehållsanalys. Huvudresultat: Det framkom fyra huvudkategorier: Patientens situation och upplevelse har betydelse för intensivvårdssjuksköterskors upplevelser, Att ha patienten i fokus, Kommunikationen med patienten är betydelsefull samt Att ha en fungerande patientnära miljö. Att vårda intuberade patienter med lätt eller ingen sedering innebar många känslor och upplevelser för intensivvårdssjuksköterskorna. Sederingsgraden uppfattades ha betydelse och om patienten kunde vara fysiskt delaktig underlättade det. Patienten var i fokus och personcentrerad vård var en viktig faktor. Patientupplevelsen fick ofta styra sederingen. Kommunikation var betydelsefullt men det fanns hinder som kunde försvåra omvårdnadsarbetet. Intensivvårdssjuksköterskorna upplevde den patientnära miljön viktig. Närvaro och uppmärksamhet krävdes, teamet spelade stor roll. Kunskap, erfarenhet och en bra planering skapade trygghet. Slutsats: Intensivvårdssjuksköterskornas upplevelser av att vårda intuberade patienter med lätt eller ingen sedering var att det krävde tid, närhet och uppmärksamhet. En lugn, trygg och bekväm patient gav en bättre upplevelse för intensivvårdssjuksköterskorna. En personcentrerad vård var viktig att bedriva och det underlättade omvårdnadsarbetet om patienten och personalen kunde kommunicera. Kunskap, erfarenhet, teamarbete och en bra planering skapade en trygg upplevelse för intensivvårdssjuksköterskorna. / Background: Deep sedation has negative effects both for mechanical ventilated patients and for the organisation. This has resulted in an increasing number of patients being treated with light or no sedation. A lower sedation grade has proven to be challenging and has placed higher demands on intensive care nurses in multiple regards.  Aim: The aim of the study was to describe intensive care nurses’ experiences of caring for intubated patients with light or no sedation. Method: A qualitative and descriptive design were implemented. Ten intensive care nurses were interviewed with semi-structured interviews. A qualitative content analysis was used. Result: Four main categories emerged: The patient's situation and experience are important for the intensive care nurses' experiences, Having the patient in focus, The communication with the patient is important and Having a functioning environment close to the patient. Caring for intubated patients with light or no sedation involved many feelings and experiences for the intensive care nurses. The degree of sedation was perceived to be important and if the patient could be physically involved it made it easier. The patient was the focus and person-centred care was an important factor. The patient experience was often allowed to guide the sedation. Communication was important, but there were obstacles that could make nursing care difficult. The intensive care nurses experienced the environment close to the patient as important. Presence and attention were required, the team played a big role. Knowledge, experience and good planning created security. Conclusion: The intensive care nurses' experiences of caring for intubated patients with light or no sedation was that it required time, presence and attention. A calm, safe and comfortable patient provided a better experience for the intensive care nurses. A person-centred care was important to carry out and it facilitated the nursing care if the patient and the staff could communicate. Knowledge, experience, teamwork and good planning created a safe experience for the intensive care nurses.

No description available.

Bakgrund: Interhospital transport [IHT] ökar inom intensivvården i Sverige. Framför allt på grund av att patienterna har ett komplext sjukdomstillstånd som kräver högspecialiserad vård men även på grund av resurs- och vårdplatsbrist. Intensivvårdssjuksköterskan ska identifiera problem och risker i förväg samt förbereda en handlingsplan utifrån oförutsedda händelser som påverkar omvårdnaden och patientsäkerheten hos den intuberade patienten. Syfte: Att beskriva intensivvårdssjuksköterskans erfarenhet av att förberedelse en intuberad patient inför interhospital transport. Metod: En intervjustudie av kvalitativ metod med induktiv ansats. Tio intervjuer genomfördes och analyserades. Analysen genomfördes utifrån Graneheim och Lundmans innehållsanalys. Resultat: Fyra huvudkategorier sammanställdes som beskriver intensivvårdssjuksköterskans erfarenhet av att förbereda en intuberad patient inför IHT. Kategorierna var: Erfarenhet ger kunskap, Teamarbete skapar överblick och En utmanade arbetssituation. Slutsats: Intensivvårdssjuksköterskans förberedelser av en intuberad patient inför IHT är en komplicerad situation och förutsätter ett gott samarbete. Erfarenheten hos intensivvårdssjuksköterskan har en stor betydelse för förberedelserna. Genom ökad erfarenhet hos intensivvårdssjuksköterskan växer egna strategier fram. Dock är den intuberade patientens tillstånd dynamiskt vilket kan leda till oförutsedda händelser. Nyexaminerade intensivvårdssjuksköterskor behöver stöttning och riktlinjer/checklistor som verktyg i sitt arbete samt kontinuerlig träning för att utveckla och upprätthålla kompetens. / Introduction: Interhospital transport [IHT] is increasing in critical care in Sweden. Mainly because the patients have a complex medical condition that requires highly specialized care, but also because of a lack of resources and care places. The critical care nurse must identify problems and risks in advance and prepare an actionplan based on unforeseen events that affect the care and patient safety of the intubated patient. Aim: To describe the critical care nurse's experience of preparing an intubated patient for interhospital transport. Method: An interview study of a qualitative method with an inductive approach. Ten interviews were conducted and analyzed. The analysis was carried out based on Graneheim and Lundman's content analysis. Result: Four main categories were compiled that describe the critical care nurse's experience of preparing an intubated patient for IHT. The categories were: Experience gives knowledge, Teamwork creates an overview, and A challenging work situation. Conclusion: Our conclusion is that the critical care nurse's preparation for IHT of an intubated patient is a team effort and a complicated situation. The experience of the critical care nurse is of great importance for the preparations. Through increased experience for the critical care nurse, own strategies develop. However, the intubated patient clinical condition is dynamic, which can lead to unpredictable events. Newly graduated critical care nurses need support and guidelines/checklists as tools in their work as well as continuous training to develop and maintain competence.

Bakgrund: Patienten som vårdas oralt intuberad på intensivvårdsavdelning får successivt försämrad munhälsa. Endotrakealtuben orsakar muntorrhet, risk för trycksår samt ansamling av bakterier och plack, vilket innebär ett lidande för patienten i form av påverkad munhälsa. Studien fokuserar på specialistsjuksköterskans roll att förebygga och lindra patientens lidande genom att undersöka munvårdsåtgärder som påverkar munhälsa. Syfte: Att sammanställa munvårdsåtgärder som påverkar munhälsa hos patienter som vårdas oralt intuberade. Metod: Kvantitativ litteraturstudie med systematisk ansats. Munvårdsåtgärdernas påverkan på munhälsa har i studierna undersökts genom olika utfallsmått och metoder. Resultatet av munvårdsåtgärdernas påverkan på munhälsa sammanställdes genom kategorierna munskölj, mekanisk rengöring, munvårdsprotokoll och fixation av endotrakealtub, uppdelat på utfallsmåtten bakterier och plack samt munslemhinnans status. Resultat: De munskölj som undersöktes resulterade i varierat positiv, utebliven och negativ påverkan på bakterier och plack samt munslemhinnan. Alla metoder av mekanisk rengöring hade positiv påverkan på munhälsa. Munvårdsprotokoll med individanpassad frekvens och ompositionering av endotrakealtuben hade positiv påverkan på munhälsa. Fixationer av endotrakealtuben påverkade munslemhinnan både positivt och negativt. Slutsats: Munvårdsåtgärder påverkar munhälsa hos patienten som vårdas oralt intuberad med både positiv, utebliven och negativ påverkan. Specialistsjuksköterskan kan förebygga samtlindra patientens lidande genom bedömning av munhälsan och tillämpning av individanpassade munvårdsåtgärder. Eftersom munvårdsåtgärder även kan leda till negativ påverkan på munhälsa är det av stor vikt att specialistsjuksköterskan även utvärderar effekten av tillämpade munvårdsåtgärder. / Background: Patients who is orally intubated in intensive care units gradually deteriorates oral health. Endotracheal tubes causes dry mouth, pressure ulcers, bacteria and plaque, which implies suffering from affected oral health. The study focuses in the specialist nurse's role in preventing and alleviating patients’ suffering by examining measures of oral care whichaffects oral health. Aim: To compile measures of oral care that affect oral health in patients who are orally intubated. Method: Quantitative literature review with systematic approach. The impact of oral care on oral health has in the studies been measured through different outcomes and methods. The result of the oral cares’ impact on oral health were compiled through the categories mouthwash, mechanical cleaning, oral care protocol and endotracheal tube fixation, divided by the outcomes bacteria and plaque and the status of oral mucosa. Results: Mouthwashes resulted in varied positive, absent and negative effects on bacteria and plaque as well as the oral mucosa. All methods of mechanical cleaning had a positive effect on oral health. Oral care protocols with individualized frequency and repositioning of the endotracheal tube had a positive effect on oral health. Endotracheal tube fixations affected the oral mucosa both positively and negatively. Conclusion: Oral care affects oral health of patients who are orally intubated with both positively, absent and negatively effect. Specialist nurses can prevent and alleviate thepatient's suffering with assessment of oral health and individualized oral care. It is of utmost importance that the nurse evaluates the effect since oral care also can result in negative impact on oral health.