Evidence - Essential readings

Question 1

Describe what Mitchell et al, 2010 study found in regards to a deteriorating patient

Answer 1

• looked at using a detailed obs chart, MEWS, MET criteria and communications of clinical instability in relation to recognising and responding to deteriorating patients
  They found with this there was reductions in:
• unplanned ICU admissions
• unexpected hospital deaths
  increase in
• medical reviews
• MET calls
• Documentation of vital signs
  CI:
• need regular vital sign recording on obs chart including everything to decrease unnecessary death

Question 2

What did Paratz and Thomas, 2008 find in regards to NP airways for suction in obese patients

Answer 2

• Appraisal - clinical scenario
• did NP suction on an obese man with inglam of brain and bronchopneumonia
• poor positing of pt and incorrect NP sizing can cause direct airway stimulation resulting laryngospasm
• NP insertion should be careful especially in patients with difficult airways
• where possible insert suction catheter until a cough occurs and no further to prevent risk of laryngospasm

Question 3

WHat did Stiller, 2013 find in there study about ICU physiotherapists

Answer 3

• systematic review
• physio intervention that comprise of progressive mobilisation is beneficial fo adult patients in ICU
• increased functional ability and reduced ICU ength of stay
• mobilisation is beneficial for critically ill patients if awake

Question 4

Paulus et al, 2012

Answer 4

• Systematic review looking at benefits and risks of MHI in ventilated patients
• insuffient evidence for benefits of MHI
• MHI is sort term improvements in ung compliance, oxygenation and secretion clearance
• MHI widely used
• continue to observe patients
• Relatively low risk

Question 5

What did Berney et al, 2002 discover in regards to MHI and VHI?

Answer 5

• RCT double cross over
• MHI then VHI 2hrs later or VHI then MHI 2 hrs later
• HI equal benefits for MHI and VHI
• both improve static pulmonary compliance, clear pulmonary secretions and then increase O2
• use either

Question 6

What did Berney et al 2004 find about positioning and MHI in ICU ventilated patients

Answer 6

• looked at this for sputum clearance and peak inspiratory flow
• side lying and head down tilt in addition to MHI improved sputum clearance and peak expiratory flow
• therefore use positioning and MHI

Question 7

describe what Green et al, 2015 discovered in regards to guidelines for mobilising ICU patients

Answer 7

• mobilisation can be safely and effectively implemented in an ICU environment
• therefore mobilise if clinical implications allow

Question 8

WHat did Needham, 2010 find in their study

Answer 8

• looked at reducing sedation and increasing rehabd and physical medicine to improve quality of life
• decreasing sedation and increasing movement and rehab improved functional mobility and decreased length of hospital stay
• therefore consider rehab and mobilisation as a valid treatment for ventilated patients
• decreasing sedations and increasing movements improves function and lwoers hospital stay