Follow-up after four-year quality improvement program to prevent inferior limb deep vein thrombosis in intensive care unit.

INTRODUCTION: Deep vein thrombosis (DVT) is a life-threatening complication in intensive care unit (ICU) patients and DVT incidence is used as a marker of quality care. In our ICU an educational program for implementation of DVT prophylaxis and ultrasound screening resulted in a remarkable decrease in DVT incidence which fell from 11.6% to 4.7%. The aim of this paper is to investigate a 4-year long persistent quality improvement of DVT prophylaxis obtained through the implementation of our educational intervention. METHODS: The study was composed of three phases: after the first retrospective investigation of DVT incidence and the evidence of the efficacy of the educational program, this third phase investigates the 2-year long sustainability and persistence in the fall of DVT incidence by the adoption of 1) an electronic form for DVT prophylaxis prescription, 2) a nursing protocol for the application of elastic stokes and 3) a personalized form with a check-list dedicated to DVT prophylaxis. Ultrasound DVT screening was performed twice a week by ICU clinicians. RESULTS: The application of DVT prophylaxis was associated with a very low incidence of DVT (2.6%) not entirely attributable to changes in characteristics of enrolled patients and/or to less intensive DVT ultrasound screening when compared to the preceding phases. Mean mechanical ventilation duration and ICU length of stay were short and similar to those of the second phase and ICU mortality did not change. CONCLUSIONS: The direct involvement of ICU clinicians and nurses in the application of DVT prophylaxis and in DVT diagnosis markedly contributed to maintain a low DVT incidence over time, despite the high turnover of patients.

Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy.

Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC) therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure.