Aust Crit Care
-
Editorial Review Meta Analysis
Oral decontamination for ventilator-associated pneumonia prevention.
-
It is everyday news that we need more intensive care unit (ICU) beds, thus effective use of existing resources is imperative. The aim of this literature review was to critically analyse current literature on how organizational factors, individual factors and teamwork factors influence the ICU discharge process. A better understanding of discharge practices has the potential to ultimately influence ICU resource availability. ⋯ Intensive care patient discharge is influenced by organisational factors, individual factors and teamwork factors. Organisational interventions are effective in reducing ICU discharge delay and shortening patient hospital stay. More rigorous research is needed to discover how these factors influence the ICU discharge process.
-
Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study.
Tracheostomy is a well established and practical approach to airway management for patients requiring extended periods of mechanical ventilation or airway protection. Little evidence is available to guide the process of weaning and optimal timing of tracheostomy tube removal. Thus, decannulation decisions are based on clinical judgement. The aim of this study was to describe decannulation practice and failure rates in patients with tracheostomy following critical illness. ⋯ Clinical assessments coupled with professional judgement to decide the optimal time to remove tracheostomy tubes in patients following critical illness resulted in a failure rate comparable with published data. Although reintubation and readmission to ICU was required in just over one third of failed decannulation episodes, there was no associated mortality or other significant adverse events. Our data suggest nurses need to exercise high levels of clinical vigilance during the first 24h following decannulation, particularly the first 4h to detect early signs of respiratory compromise to avoid adverse outcomes.