The Effect of a Quality Improvement Intervention on Perceived Sleep Quality and Cognition in a Medical ICU.
The Effect of a Quality Improvement Intervention on Perceived Sleep Quality and Cognition in a Medical ICU.
Filed under: Rehab Centers
Crit Care Med. 2013 Jan 10;
Kamdar BB, King LM, Collop NA, Sakamuri S, Colantuoni E, Neufeld KJ, Bienvenu OJ, Rowden AM, Touradji P, Brower RG, Needham DM
OBJECTIVES:: To determine if a quality improvement intervention improves sleep and delirium/cognition. DESIGN:: Observational, pre-post design. SETTING:: A tertiary academic hospital in the United States. PATIENTS:: 300 medical ICU patients. INTERVENTIONS:: This medical ICU-wide project involved a “usual care” baseline stage, followed by a quality improvement stage incorporating multifaceted sleep-promoting interventions implemented with the aid of daily reminder checklists for ICU staff. MEASUREMENTS AND MAIN RESULTS:: Primary ICU outcomes were perceived sleep quality and noise ratings (measured on a 0-100 scale using the valid and reliable Richards-Campbell Sleep Questionnaire) and delirium/coma-free days. Secondary outcomes included ICU and hospital length of stay and mortality. Post-ICU measures of cognition and perceived sleep quality were evaluated in an ICU patient subset. During the baseline and sleep quality improvement stages, there were 122 and 178 patients, respectively, with more than one night in the ICU, accounting for 634 and 826 patient-days. Within the groups, 78 (63.9%) and 83 (46.6%) patients received mechanical ventilation. Over the 826 patient-day quality improvement period, checklist item completion rates ranged from 86% to 94%. In multivariable regression analysis of the quality improvement vs. baseline stages, improvements in overall Richards-Campbell Sleep Questionnaire sleep quality ratings did not reach statistical significance, but there were significant improvements in daily noise ratings (mean ± SD: 65.9 ± 26.6 vs. 60.5 ± 26.3, p = 0.001), incidence of delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23-0.89; p = 0.02), and daily delirium/coma-free status (odds ratio: 1.64; 95% confidence interval, 1.04-2.58; p = 0.03). Improvements in secondary ICU outcomes and post-ICU outcomes did not reach statistical significance. CONCLUSIONS:: An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance. (Crit Care Med 2013; 41:0-0).
HubMed – rehab
Thiamine and spinocerebellar ataxia type 2.
Filed under: Rehab Centers
BMJ Case Rep. 2013; 2013:
Costantini A, Pala MI, Colangeli M, Savelli S
Spinocerebellar ataxia type 2 is a genetic disorder characterised by the degeneration of the cerebellum, its connections and degeneration in brainstem areas. Some observations indicate that high doses of thiamine may lead to the partial regression of the symptoms. One patient was under rehabilitative treatment from June 2011 to July 2012. We assessed the level of fatigue using the Fatigue Severity Scale. We performed the Scale for Assessment and Rating of Ataxia and Robertson Profile for Dysarthria (Italian version). Thiamine and thiamine pyrophosphate levels in the blood were within the healthy reference range. We started a parenteral therapy with 100 mg intramuscular every 7 days. The therapy led to a partial regression of fatigue within a few days. After about 3 months, a discreet improvement of motor symptoms especially in speech was observed. The symptoms could derive from a focal thiamine deficiency that could determine a selective neuronal loss.
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Effect of Body Position on Ventilation Distribution in Ventilated Preterm Infants.
Filed under: Rehab Centers
Pediatr Crit Care Med. 2013 Jan 9;
Hough JL, Johnston L, Brauer S, Woodgate P, Schibler A
RATIONALE:: Positioning is considered vital to the maintenance of good lung ventilation by optimizing oxygen transport and gas exchange in ventilated premature infants. Previous studies suggest that the prone position is advantageous; however, no data exist on regional ventilation distribution for this age group. OBJECTIVES:: To investigate the effect of body position on regional ventilation distribution in ventilated and nonventilated preterm infants using electrical impedance tomography. DESIGN:: Randomized crossover study design. SETTING:: Neonatal ICU. PATIENTS:: A total of 24 ventilated preterm infants were compared with six spontaneously breathing preterm infants. INTERVENTIONS:: Random assignment of the order of the positions supine, prone, and quarter prone. MEASUREMENTS AND MAIN RESULTS:: Ventilation distribution was measured with regional impedance amplitudes and global inhomogeneity indices using electrical impedance tomography. In the spontaneously breathing infants, regional impedance amplitudes were increased in the posterior compared with the anterior lung (p < 0.01) and in the right compared with the left lung (p = 0.03). No differences were found in the ventilated infants. Ventilation was more inhomogeneous in the ventilated compared with the healthy infants (p < 0.01). Assessment of temporal regional lung filling showed that the posterior lung filled earlier than the anterior lung in the spontaneously breathing infants (p < 0.02) whereas in the in the ventilated infants the right lung filled before the left lung (p < 0.01). CONCLUSIONS:: In contrast to previous studies showing that ventilation is distributed to the nondependent lung in infants and children, this study shows that gravity has little effect on regional ventilation distribution. HubMed – rehab
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