Abstract
Critical Care Science. 01-30-2025;37:e20250128
DOI 10.62675/2965-2774.20250128
Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families. Timely physical therapy plays a crucial role in mitigating intensive care unit-acquired weakness and postintensive care syndrome. Key recommendations for the effective rehabilitation of patients in the intensive care unit include education and training, communication and collaboration, patient screening, planning of activities, distribution of functions focused on teamwork, patient cooperation, safety assessments, patient positioning, functional mobilization, and documentation of outcomes. This narrative review aims to update the current understanding of the influence of physical therapy and critical care teamwork on intensive care unit patients and to provide evidence-based recommendations for promoting early mobilization in the intensive care unit setting.
Abstract
Critical Care Science. 11-26-2024;36:e20240116en
DOI 10.62675/2965-2774.20240116-en
To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.
This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.
Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.
Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.
Abstract
Critical Care Science. 08-26-2024;36:e20240150en
DOI 10.62675/2965-2774.20240150-en
In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.
Abstract
Revista Brasileira de Terapia Intensiva. 09-12-2022;34(3):327-334
DOI 10.5935/0103-507X.20220070-en
To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections.
This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period.
The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections.
The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.
Abstract
Revista Brasileira de Terapia Intensiva. 01-01-2014;26(1):7-13
DOI 10.5935/0103-507X.20140002
To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process.
A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff training.
Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in the post-intervention period with a total of 1246 and 1191 observations respectively. Among the indicators related to the global population, there was a significant improvement in chest x-ray control, multidisciplinary rounds and shift changes as well as in compliance with these decisions. Indicators related to the population under mechanical ventilation, obtained by direct observation at bedside, showed a significant improvement in the compliance with the tidal volume of 6-8mL/Kg, plateau pressure <30cmH2O, adequate mechanical ventilation alarm setting, mechanical ventilation humidification control, adequate humidification line exchange and orotracheal tube position. Among the mechanical ventilation indicators collected through the physiotherapy records, there was significantly improved compliance with the predicted tidal volume registry and cuff pressure registry. There was a significant reduction in the number of adverse events. There was no impact on intensive care unit mortality, length of stay, duration of mechanical ventilation and ventilator-free days.
It is possible to measure the quality of physiotherapy care using indicators of quality control. The implementation of care protocols and training of the professionals can improve team performance.