Heart & lung : the journal of critical care
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Review
Ventilator-associated events prevention, learning lessons from the past: A systematic review.
Preventing Ventilator-associated events (VAE) is a major challenge. Strictly monitoring for ventilator-associated pneumonia (VAP) is not sufficient to ensure positive outcomes. Therefore, the surveillance definition was updated and a change to the broader VAE was advocated. ⋯ VAP prevention bundles have historically proven their efficacy and the introduction of the new VAE definition aimed at refining and objectivizing surveillance methods. Randomized controlled trials remain vital to determine the effect of VAE prevention on patient outcomes. We recommend expanding beyond limited VAP prevention strategies towards VAE prevention bundles.
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To identify barriers to sleep for intensive care unit (ICU) patients. ⋯ This qualitative study suggests that health care worker attitudes, methods of sleep promotion, hospital institutional policies and workflow may contribute to sleep disruption in the ICU. These barriers provide additional targets for intervention in studies designed to improve sleep in the ICU.
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Review Meta Analysis Comparative Study
Efficacy of noninvasive ventilation after planned extubation: A systematic review and meta-analysis of randomized controlled trials.
The objective our meta-analysis is to update the evidence on the efficacy of noninvasive ventilation (NIV) compared with conventional oxygen therapy after planned extubation. We did a systematic literature review of database, including Pubmed, EMBASE, and Cochrane. We included randomized controlled trials comparing NIV with conventional oxygen therapy after planned extubation in medical intensive care unit (ICU) in our analysis. ⋯ However, in a mixed medical ICU population, there was no statistical difference of reintubation rate between the two groups (RR, 0.66; 95% CI, 0.25-1.73; I2 = 68%). Our study suggests that use of NIV after planned extubation significantly decreases the reintubation rate in COPD patients and patients at high risk for extubation failure, confirming the findings of previous reviews. There is no difference in the reintubation rate between the two groups in the mixed medical ICU population.
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To examine the prevalence of insomnia and its relationship to health-related quality of life (HRQOL) post-intensive care unit (ICU). ⋯ Insomnia is common among ICU survivors. Post-ICU insomnia is significantly associated with mental HRQOL and could identify ICU survivors who may benefit from further psychiatric evaluation.
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Acute coronary syndrome (ACS) is best managed by a multidisciplinary team in which primary care physicians, physician assistants, nurse practitioners, and pharmacists play a key role. This article summarizes recent updates to American College of Cardiology Foundation/American Heart Association guidelines for the management of unstable angina (UA)/non ST-segment elevation ACS (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), focusing on antiplatelet therapy. ⋯ The guidelines provide recommendations regarding the utilization of P2Y12 inhibitors in specific circumstances and are discussed in this review. Health care teams with a key role in post-ACS care need to be familiar with the latest guidelines and support patients with education on risk reduction and the benefits of long-term medication adherence.