RESUMEN
OBJECTIVES: There is growing evidence to support early mobilization of adult mechanically ventilated patients in ICUs. However, there is little knowledge regarding early mobilization in routine ICU practice. Hence, the interdisciplinary German ICU Network for Early Mobilization undertook a 1-day point-prevalence survey across Germany. DESIGN: One-day point-prevalence study. SETTING: One hundred sixteen ICUs in Germany in 2011. PATIENTS: All adult mechanically ventilated patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For a 24-hour period, data were abstracted on hospital and ICU characteristics, the level of patient mobilization and associated barriers, and complications occurring during mobilization. One hundred sixteen participating ICUs provided data for 783 patients. Overall, 185 patients (24%) were mobilized out of bed (i.e., sitting on the edge of the bed or higher level of mobilization). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 8%, 39%, and 53% were mobilized out of bed, respectively (p < 0.001 for difference between three groups). The most common perceived barriers to mobilizing patients out of bed were cardiovascular instability (17%) and deep sedation (15%). Mobilization out of bed versus remaining in bed was not associated with a higher frequency of complications, with no falls or extubations occurring in those mobilized out of bed. CONCLUSIONS: In this 1-day point-prevalence study conducted across Germany, only 24% of all mechanically ventilated patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of routine care. Addressing modifiable barriers for mobilization, such as deep sedation, will be important to increase mobilization in German ICUs.
Asunto(s)
Ambulación Precoz/estadística & datos numéricos , Modalidades de Fisioterapia/estadística & datos numéricos , Respiración Artificial , Adulto , Estudios Transversales , Sedación Profunda , Femenino , Alemania , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate a) the magnitude of the increase in caloric consumption due to early mobilisation of patients with mechanical ventilation (MV) in Intensive Care Units (ICU) as part of routine care, b) whether there are differences in caloric consumption due to active or passive mobilisation, and c) whether early mobilisation in routine care would lead to additional nutritional requirements. DESIGN: Prospective, observational, multi-centre study. SETTING: Medical, surgical and neurological ICUs from three centres. PATIENTS: Patients on MV in ICU who were mobilised out of bed as part of routine care. MEASUREMENTS AND MAIN RESULTS: Caloric consumption was assessed in 66 patients by indirect calorimetry at six time points: (1) lying in bed 5-10 min prior to mobilisation, (2) sitting on the edge of the bed, (3) standing beside the bed, (4) sitting in a chair, (5) lying in bed 5-10 min after mobilisation, and (6) 2 h after mobilisation. Differences in caloric consumption in every mobilisation level vs. the baseline of lying in bed were measured for 5 min and found to have increased significantly by: +0.4 (Standard Deviation (SD) 0.59) kcal while sitting on the edge of the bed, +1.5 (SD 1.26) kcal while standing in front of the bed, +0.7 (SD 0.63) kcal while sitting in a chair (all p < 0.001). Active vs. passive transfers showed a higher, but non-significant consumption. A typical sequence of mobilisation including sitting on edge of the bed, standing beside the bed, sitting in a chair (20 min) and transfer back into bed, would require an additional 4.56 kcal compared to caloric consumption without mobilisation. CONCLUSIONS: Based on this data, routine mobilisation of MV patients in ICU increases caloric consumption, especially in active mobilisation. Nevertheless, an additional caloric intake because of routine mobilisation does not seem to be necessary.
Asunto(s)
Calorimetría Indirecta , Ambulación Precoz/métodos , Metabolismo Energético/fisiología , Respiración Artificial , Caminata/fisiología , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The operating theatre is one of the most expensive areas in German hospitals. Contributing to high cost are badly arranged perioperative processes, which should be avoided. An appreciation of processing times and an illustration of department-specific operating figures are vital in order to ensure cost-efficiency. Specific software based on DRG-data is available to evaluate processing-times from an economic perspective.
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Anestesiología/economía , Anestesiología/estadística & datos numéricos , Eficiencia Organizacional , Costos de la Atención en Salud/estadística & datos numéricos , Modelos Económicos , Programas Informáticos , Factores de Tiempo , Alemania , Carga de TrabajoRESUMEN
National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues. The program includes interdisciplinary consented evidence based algorithms to help with immediate diagnostics and initial anti-infective therapies. Currently, with the title "ABx local" a subproject is launched to broaden program functions. It unifies current evidence based recommendations and local internal standards or comments on one platform to achieve priority of therapy options e.g. based on resistance patterns.
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Infecciones Bacterianas/terapia , Sistemas de Apoyo a Decisiones Administrativas , Técnicas de Apoyo para la Decisión , Medicina Basada en la Evidencia , Internet , Programas Informáticos , Terapia Asistida por Computador/métodos , Algoritmos , Cuidados Críticos/métodos , Alemania , Humanos , Difusión de la Información/métodos , Sistemas en LíneaAsunto(s)
Reposo en Cama/efectos adversos , Enfermedad Crónica/enfermería , Enfermería de Cuidados Críticos/métodos , Ambulación Precoz/enfermería , Adulto , Anciano , Enfermedad Crónica/rehabilitación , Conducta Cooperativa , Femenino , Alemania , Humanos , Comunicación Interdisciplinaria , Tiempo de Internación , MasculinoRESUMEN
In order to improve quality (of therapy), one has to know, evaluate and make transparent, one's own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state.Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches.Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs).
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Cuidados Críticos/legislación & jurisprudencia , Cuidados Críticos/normas , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/normas , AlemaniaRESUMEN
Critical care medicine frequently involves decisions and measures that may result in significant consequences for patients. In particular, mistakes may directly or indirectly derive from daily routine processes. In addition, consequences may result from the broader pharmaceutical and technological treatment options, which frequently involve multidimensional aspects. The increasing complexity of pharmaceutical and technological properties must be monitored and taken into account. Besides the presence of various disciplines involved, the provision of 24-hour care requires multiple handovers of significant information each day. Immediate expert action that is well coordinated is just as important as a professional handling of medicine's limitations.Intensivists are increasingly facing professional quality management within the ICU (Intensive Care Unit). This article depicts a practical and effective approach to this complex topic and describes external evaluation of critical care according to peer reviewing processes, which have been successfully implemented in Germany and are likely to gain in significance.