Evidence - Lectures

Question 1

What did Goldhill et al, 1999 find about admissions to ICU

Answer 1

• studies 76 unplanned admissions in ICU
• found that a RR > 25 most common physiological abnormality
• CI: RR >25 may be best predictor of an ICU admission

Question 2

Describe what Bruist et al, 2004 studies about ICU patients

Answer 2

• Found that a high RR > 30 and low RR of < 2 associated with a high odds ratio for risk of mortality
• CI: RR may be best predictor

Question 3

Cooper et al, 2011 looked into bifrontal decompressive craniectomy, describe what they found.

Answer 3

• RCT of the bifrontal craniectomy in TBI patients
• found the craniectomy group there was a lower ICP’s in ICU, fewer interventions for ICP, fewer days in ICU
  But - there was also worse outcomes at 6 months
• therefore this surgery may be appropriate management but try conservative treatment first

Question 4

Patman et al, 2009 looked into Physiotherapy versus no physiotherapy . What did they find?

Answer 4

• 144 ABi patients with GCS <9
• Intervention group included: positioning, MHI, suction every 24 hrs
• control group had no chst therapy
• 33 pt’s developed ventilator associated pneumonia
• no difference between groups VAP incidence, duraction of MV or LOS in ICU
• small sample size - limitation
• CI: physio doesn’t prevent or hasten recovery

Question 5

What did Prabhu et al, 2013 discover?

Answer 5

• Cochrane review
• passive mvmt for RX and prevention of contractures
• no evidence PROM prevents contracture despite previous evidence
• suggests prolonged stretching may be beneficial
• Clinical implications: prolonged positioning and pharmaceutical interventions benefical but not PROM

Question 6

Chang et al, 2004 performed a survery of Australian physios. Describe

Answer 6

• survey regarding implementation of tilt table in ICU
• 67% physios use tilt tables
• common reasons include - facilitate WBing, prevent contracture, improve LL strength, increase arousal
  Clinical Implications: combine tilt table with UL exercises and breathing exercises for max effectiveness and efficiancy

Question 7

What did WIlliam et al, 2007 discover about ICUAW?

Answer 7

• analysis to discover risk factors associated with increase incidence of ICU acquired weakness
• Risk factors for ICUAW include: Prolonged MV, Severe systemic inflam, Medications (steroids + neuromuscular blocking agents), poor glycemic control, immobility
• strong associated between ICUAW and ventilator dependence, an important determinant of ICU LOS
• Clinical Implications: identify risk factors early