To stay in touch - intensive care patients' interactions with nurses during mobilisation.

BACKGROUND: Minimal sedation has made it possible to communicate and cooperate with intensive care patients and mobilisation can start earlier during their stay in the intensive care unit. PURPOSE: To investigate the intensive care patient's reaction and interaction to mobilisation. METHOD: This study used focused ethnography combining observations, interviews and four scores for evaluating awareness, and pain levels were included: Richmond Agitation Sedation Scale Confusion Assessment Method For The Intensive Care Unit, Numeric Rating Scale and Critical Pain Observation Tool. Twelve patients were observed during mobilisation, with subsequent interviews of the involved nurses. FINDINGS: Nurses run the risk of overlooking the patient's reactions, such as pain, discomfort or needs during mobilisation. Nurses use several different ways of communicating to create contact with the patients. Patients with an impaired awareness level become more aware during mobilisation. CONCLUSIONS: If the nurse's attention is focused on the technical side of caregiving, there is a risk that she might overlook the patient's reactions and needs. If the nurse is aware of the risk of overlooking the patient's reactions, she may plan the mobilisation to ensure that the patient gets the necessary attention and is included in the process. In that way, the patient might avoid unnecessary discomfort and maintain trust and confidence in the nurse.

Long-term mortality and health-related quality of life of lower versus higher oxygenation targets in ICU patients with severe hypoxaemia.

PURPOSE: We assessed outcomes after 1 year of lower versus higher oxygenation targets in intensive care unit (ICU) patients with severe hypoxaemia. METHODS: Pre-planned analyses evaluating 1-year mortality and health-related quality-of-life (HRQoL) outcomes in the previously published Handling Oxygenation Targets in the ICU trial which randomised 2928 adults with acute hypoxaemia to targets of arterial oxygen of 8 kPa or 12 kPa throughout the ICU stay up to 90 days. One-year all-cause mortality was assessed in the intention-to-treat population. HRQoL was assessed using EuroQol 5 dimensions 5 levels (EQ-5D-5L) questionnaire and EQ visual analogue scale score (EQ-VAS), and analyses were conducted in both survivors only and the intention-to-treat population with assignment of the worst scores to deceased patients. RESULTS: We obtained 1-year vital status for 2887/2928 (98.6%), and HRQoL for 2600/2928 (88.8%) of the trial population. One year after randomisation, 707/1442 patients (49%) in the lower oxygenation group vs. 704/1445 (48.7%) in the higher oxygenation group had died (adjusted risk ratio 1.00; 95% confidence interval 0.93-1.08, p = 0.92). In total, 1189/1476 (80.4%) 1-year survivors participated in HRQoL interviews: median EQ-VAS scores were 65 (interquartile range 50-80) in the lower oxygenation group versus 67 (50-80) in the higher oxygenation group (p = 0.98). None of the five EQ-5D-5L dimensions differed between groups. CONCLUSION: Among adult ICU patients with severe hypoxaemia, a lower oxygenation target (8 kPa) did not improve survival or HRQoL at 1 year as compared to a higher oxygenation target (12 kPa).