Australian Critical Care - Articles in Press

Paracetamol induced skin blood flow and blood pressure changes in febrile intensive care patients: An observational study - Corrected Proof

2010-07-23

Summary: Objective: To determine the relationship between paracetamol administration and skin blood flow (skBF) and blood pressure (BP) in critically ill patients treated for fever.Design: Prospective, observational study.Setting: Intensive care units of university teaching hospital.Patients: 29 adults (17 males and 12 females), aged 58±15 years treated with enteral or intravenous paracetamol for fever. APACHE II score was 17.2±8.3 and admission classifications were 41% medical (n=12), 31% surgical (n=9), and 28% neurological intervention (n=8). Thirty healthy afebrile volunteers were also studied after ingesting 1g paracetamol.Measurements and main results: Temperature, BP and skBF (laser Doppler flowmetry perfusion units) were recorded 15min prior to administration of paracetamol, at administration (T0) and then for every 15min for 60min. Cutaneous vascular conductance (CVC=skBF/mean arterial pressure) was calculated. Thirty data sets were recorded from 29 patients. Temperature at T0 was 38.7±0.6°C. BP decreased over the study period whilst skBF and CVC increased (repeated measured ANOVA, p<.05). Systolic BP decreased significantly (p<.01) at all post-administration times and was 90±13% of T0 at 60min. CVC was 128±48% of T0 at 60min. Systolic BP fell by a clinically significant amount (≥15%) in 17 patients (59%) and hypotension was treated during 33% (n=10) of the observation periods. BP and skBF did not change significantly in afebrile volunteers.Conclusions: Paracetamol induced increases in skBF consistent with its antipyretic action and may be associated with significant falls in BP in the critically ill.

Determination of body weight and height measurement for critically ill patients admitted to the intensive care unit: A quality improvement project - Corrected Proof

Elke Freitag, Gay Edgecombe, Ian Baldwin, Brendan Cottier, Melodie Heland — 2010-06-25

Summary: Purpose: Measuring body weight and height of critically ill patients in intensive care often challenge nurses. Estimated weight and height is thought to be inaccurate. This quality improvement project was to determine one effective method of how all patients in intensive care unit (ICU) could be measured and weighed accurately and cost effectively. The determined method also was to be Occupation Health and Safety safe, adhere to infection control standards and minimises risks of patient handling. The focus for this quality improvement was that the measurement methods were to be utilised in conjunction with a baseline patient assessment in the ICU.Methods: Six different types of weighing scales were compared. Three methods were tested in a workshop for accuracy. The results were compared to a ‘standing scale’ as the ‘gold standard’ for body weight. The second stage of the project was to determine the body height of patients in the supine position. The tools were designed by the quality improvement team (QIT) and manufactured by the hospital Departments. The methods were also tested in a workshop for accuracy. The measurements were compared to a wall mounted stadiometer as the ‘gold standard’.Results: The two height measurement tools displayed differences of −1.2 to +3cm. The first weighing results of three methods showed variations. The methods displayed differences from 0.8 to 25kg. The aluminium height measurement tools and the Mercury scale conformed to the standard agreed to by the QIT.Discussion: Staff in the ICU required minimal training for the methods used. The uptake of a measured weight and height, in difference to estimation takes some time for staff to accept and use. Case exemplars that demonstrated an error rate with estimation were useful feedback towards the change in practice.Conclusion: It was found that critically ill patients could be weighed effectively and accurately with a scale usable for every type of bed available in this ICU. All supine positioned patients can also be measured effectively and accurately with one height measurement method. These methods do not require the patient to be moved. There is no need to disconnect lines or monitoring equipment at any time during the measuring procedures.

Should gastric aspirate be discarded or retained when gastric residual volume is removed from gastric tubes? - Corrected Proof

Teresa A. Williams, Gavin D. Leslie — 2010-06-17

Summary: Nursing care of patients with enteral feeding tubes is common in the intensive care unit but the evidence that surrounds the practice is limited. Recent research by Juve-Udina and colleagues (2010) “To return or to discard? Randomised trial on gastric residual volume management” compares two methods of managing gastric residual volume. This critique provides a brief summary of their research and critically appraises the paper. The implications for nursing practice are discussed.

‘Changes of concern’ for detecting potential early clinical deterioration: A validation study - Corrected Proof

Jane Cioffi, Richard Conway, Leanne Everist, Janet Scott, John Senior — 2010-05-31

Summary: Background: The criteria used for calling emergency response teams to patients at-risk of clinical deterioration in the acute care adult hospital population include the criterion ‘patient of concern’. When calling teams to patients of concern, some ‘changes of concern’ used by nurses have been identified; however the validity of these ‘changes of concern’ is unknown.Purpose: This study aimed to determine the content validity of ‘changes of concern’ used by nurses to call emergency response teams.Methods: Ten nurses who had 5 years or more experience with emergency response teams formed an expert group. This expert group examined content validity of the ‘changes of concern’ nurses used for calling emergency response teams using criterion, ‘patient of concern’ with a questionnaire based on Bausell's content validity criteria of necessity and sufficiency. Data were summarized using descriptive statistics.Findings: The main findings indicate that the 10 ‘changes of concern’ are agreed to be necessary to possibly identify early deterioration in adult patients that may require a call using criterion, ‘patient of concern’. The associated factors that relate to these ‘changes of concern’ are also confirmed to be necessary to assess when these changes are present in patients.Conclusion: Assessment underpinned by these changes of concern (indicators) can provide more complete clinical information for clinicians to recognise possible early deterioration of patients and to coach others so building capacity to appropriately call emergency response teams resulting in increased patient safety. Research is indicated that further explores and identifies the use of ‘patient of concern’ criterion and that examines the effectiveness of clinical information being used to detect potential early clinical deterioration.

Development of clinical practice guidelines for the nursing care of people undergoing percutaneous coronary interventions: An Australian & New Zealand collaboration - Corrected Proof

John X. Rolley, Yenna Salamonson, Cheryl R. Dennison, Patricia M. Davidson — 2010-04-23

Summary: Aim: This paper describes the development of nursing practice guidelines for percutaneous coronary intervention (PCI).Background: Clinical practice guidelines (CPGs) supporting PCI nursing care are limited.Method: The National Health and Medical Research Council's (NH&MRC) health and medical practice development guidelines were used for the guideline development process. A panel of experts (clinicians and consumers) attended a consensus conference to review existing evidence. Subsequently, nurses’ opinions were identified via an online survey. This was followed by a modified Delphi method was used to refine a draft set of guidelines over two rounds.Results: The consensus conference was attended by 41 participants (39 cardiovascular nurses and 2 consumer representatives). Eight additional members joined the panel for the modified Delphi rounds with 27 participants completing the online survey. The final guideline document consisted of 75 recommendations. Endorsement was then sought from key peak cardiovascular bodies in Australia and New Zealand.Discussion/conclusion: Inconclusive evidence precludes definitive recommendations. Therefore, consultation and consensus are important in developing guidelines to achieve standardised nursing care and monitoring of outcomes.Implications for practice: Nurses play a crucial role in PCI care, yet currently there are limited guidelines to inform practice. This paper describes the method developing clinical practice guideline and deriving consensus.