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4. Physical therapy on the wards after early physical activity and mobility in the intensive care unit

Author

Hopkins, Ramona O., Miller, III, Russell R., Rodriguez, Larissa, Spuhler, Vicki, and Thomsen, George E.

Subjects
Exercise -- Health aspects, Therapeutics, Physiological -- Health aspects, Physical therapy -- Health aspects, Hospital patients -- Care and treatment, Health
Abstract

Background. Weakness and debilitation are common following critical illness. Studies that assess whether early physical activity initiated in the intensive care unit (ICU) continues after a patient is transferred to a ward are lacking. Objective. The purpose of this study was to assess whether physical activity and mobility initiated during ICU treatment were maintained after patients were discharged from a single ICU to a ward. Design. This was a cohort study. Methods. Consecutive patients who were diagnosed with respiratory failure and admitted to the respiratory ICU (RICU) at LDS Hospital underwent early physical activity and mobility as part of usual care. Medical data, the number of requests for a physical therapy consultation or nursing assistance with ambulation at ICU discharge, and mobility data were collected during the first 2 full days on the ward. Results. of the 72 patients who participated in the study, 65 had either a physical therapy consultation or a request for nursing assistance with ambulation at ward transfer. Activity level decreased in 40 participants (55%) on the first full ward day. Of the 61 participants who ambulated 100 ft (30.48 m) or more on the last full RICU day, 14 did not ambulate, 22 ambulated less than 100 ft, and 25 ambulated 100 ft or more on the first ward day. Limitations. Limitations include lack of data regarding why activity was not performed on the ward, lack of longitudinal follow-up to assess effects of activity, and lack of generalizability to patients not transferred to a ward or not treated in an ICU with an early mobility program. Conclusions. Despite the majority of participants having a physical therapy consultation or a request for nursing assistance with ambulation at the time of transfer to the medical ward, physical activity levels decreased in over half of participants on the first full ward day. The data suggest a need for education of ward staff regarding ICU debilitation, enhanced communication among care providers, and focus on the importance of patient-centered outcomes during and following ICU treatment., Decreased mortality associated with progress in critical care results in increasing numbers of survivors of an intensive care unit 0CU) admission. (1) For many ICU survivors, critical illness and its [...]

Published
2012
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8. Clinical Performance of a Rule-Based Decision Support System for Mechanical Ventilation of ARDS Patients

Author

Thomsen, George E., Pope, Donna, East, Thomas D., Morris, Alan H., Kinder, A. Tupper, Carlson, Debra A., Smith, Gordon L., Wallace, C. Jane, Orme, James F., Clemmer, Terry P., Weaver, Lindell K., Thomas, Frank, and Dean, Nathan C.

Subjects
Respiratory Distress Syndrome, Clinical Protocols, Therapy, Computer-Assisted, Decision Support in the Intensive Care Unit, Humans, Respiration, Artificial, Decision Support Techniques
Abstract

We developed a clinical decision support system--ventilation protocols--that managed tidal volume and ventilator rate settings during mechanical ventilation of patients with the Adult Respiratory Distress Syndrome (ARDS). We applied these protocols for a total of 10,903 hours in 40 ARDS patients. The clinical staff suspended the protocols for only 5% of the total application time due to medical procedures, surgeries, transient clinical problems not addressed by the protocols, or because of attending physician request. Of 3,148 instructions generated by the ventilation protocols, the clinical staff followed 2,932 (93%). The staff did not follow some instructions because of patient data errors, computer software and protocol logic errors, inability of the clinical staff to implement protocol instructions because of more pressing duties, and clinical staff objections to specific instructions. Sixty percent of the patients treated by the ventilation protocols survived. Our results demonstrate that the ventilation protocols provided a practical and safe decision support system for the mechanical ventilation of ARDS patients.

Published
1993

17. Unit-wide notification of ventilator disconnections.

Author

Evans RS, Johnson KV, Flint VB, Kinder AT, Hawley WL, Lyon CR, Vawdrey DK, and Thomsen GE

Subjects
Equipment Failure, Humans, Intensive Care Units, Microcomputers, Ventilators, Mechanical
Abstract

The alarms generated by mechanical ventilators when patients become disconnected can blend in with other typical sounds of the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. We developed a unit-wide system to monitor ventilator disconnection alarms. When a disconnection is identified, the system takes control of every computer in the patient's intensive care unit and generates an enhanced audio and visual alert. This system was tested in four ICUs at LDS Hospital. Acceptance by medical personnel was very high and patient safety was improved through early intervention that avoided prolonged hypoxia. In addition, the system facilitated root cause analyses and new safety strategies.

Published
2005

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