Impact of early percutaneous dilatative tracheostomy in patients with subarachnoid hemorrhage on main cerebral, hemodynamic, and respiratory variables: A prospective observational study.

Introduction: Patients with poor-grade subarachnoid hemorrhage (SAH) admitted to the intensive care unit (ICU) often require prolonged invasive mechanical ventilation due to prolonged time to obtain neurological recovery. Impairment of consciousness and airway protective mechanisms usually require tracheostomy during the ICU stay to facilitate weaning from sedation, promote neurological assessment, and reduce mechanical ventilation (MV) duration and associated complications. Percutaneous dilatational tracheostomy (PDT) is the technique of choice for performing a tracheostomy. However, it could be associated with particular risks in neurocritical care patients, potentially increasing the risk of secondary brain damage. Methods: We conducted a single-center, prospective, observational study aimed to assess PDT-associated variations in main cerebral, hemodynamic, and respiratory variables, the occurrence of tracheostomy-related complications, and their relationship with outcomes in adult patients with SAH admitted to the ICU of a neurosurgery/neurocritical care hub center after aneurysm control through clipping or coiling and undergoing early PDT. Results: We observed a temporary increase in ICP during early PDT; this increase was statistically significant in patients presenting with higher therapy intensity level (TIL) at the time of the procedural. The episodes of intracranial hypertension were brief, and appeared mainly due to the activation of cerebral autoregulatory mechanisms in patients with impaired compensatory mechanisms and compliance. Discussion: The low number of observed complications might be related to our organizational strategy, all based on a dedicated "tracheo-team" implementing both PDT following a strictly defined protocol and accurate follow-up.

[The tracheo-team in the management of intracranic pressure during a dilatative tracheostomy in severe head trauma: the impact of a checklist]. / Il tracheo-team nella gestione della pressione endocranicadurante tracheostomia dilatativa nel trauma cranico grave:l'impatto di una checklist.

. The tracheo-team in the management of intracranic pressure during a dilatative tracheostomy in severe head trauma: the impact of a checklist. INTRODUCTION: Percutaneous dilatative tracheostomy (PDT) is a common technique in neurosurgical intensive care. However, it may cause imbalances of brain parameters causing secondary damages. AIM: To assess the intra cranic pressure (ICP) values and the safety of PDT performed by a tracheo-team of doctors and nurses, according to a procedure described in a checklist, in patients with severe head trauma. METHODS: All patients with severe head trauma, admitted from 2005 to 2015, exposed to PDT and with monitoring, before and after the PDT, of brain parameters (ICP and cerebral perfusion pressure) and mechanical ventilation, were included. The PDT was performed according to a checklist developed by the ward staff. RESULTS: 1571 patients with severe head trauma were admitted: 721 underwent a PDT, the ICP was monitored in 422. A temporary increase of ICP (>30mmhg) was overall observed in 11.5% of cases among those with baseline ICP >20, >20 and <10mmhg, respectively in 25, 8 and 4% of cases. Major complications were not observed; minor complications were <4%. CONCLUSIONS: Overall and intracranial hypertension complications PDT related are lower than reported in the literature. A checklist for PDT with tracheo-team of nurses and doctors with experience in neuro intensive care allows a safe and reliable management of the procedure in severe head trauma patients.

A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals.

BACKGROUND AND AIM OF THE WORK: Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration. METHOD: Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration. RESULTS: Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided. CONCLUSION: The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the aspects investigated. Considering the shared perception among the professions studied, compared to the constructs under investigation, it seems to be clear how the routes should be designed in a systematic order to involve, in an integrated way the best professionals (nurses, doctors and OSS) involved in taking managing critical patients. No statistically significant difference have been found between these three professions considered, on most dimensions of job satisfaction investigated (relations between colleagues, 'social interactions, work-family balance, time work organization and working professional opportunity). There is a difference between two specific factors: the work time planning organization and wich is seen less by the nurses, while the job opportunities that are perceived less from the OOS.