Use of a sacral silicone border foam dressing as one component of a pressure ulcer prevention program in an intensive care unit setting.

In 2008, patients in the intensive care unit (ICU) at Danbury Hospital, Danbury, Connecticut, experienced 79 pressure ulcers. As a result, pressure ulcer-prevention interventions were standardized in critical care and medical-surgical units and education was provided to all direct patient care staff about principles of skin care and prevention. Following these efforts, 53 ICU patients developed pressure ulcers in the sacral area in fiscal year 2009, representing a 12.5% incidence for the ICU as compared to a 3.4% overall pressure ulcer incidence for the total hospital. In order to achieve additional reduction in pressure ulcer incidence, we replicated an initiative that called for application of a silicone foam dressing every 3 days to determine its effect on sacral pressure ulcer incidence in the ICU. We found that the use of the dressing further diminished the incidence of sacral pressure ulcers in our patients.

Practice variability in the assessment and treatment of critical illness-related corticosteroid insufficiency.

PURPOSE: Little is known about how published evidence regarding use of steroids in septic shock has been incorporated into clinical practice. MATERIALS AND METHODS: All patients admitted to an intensive care unit at a single, tertiary-care, academic medical center from November 1, 2004, through February 28, 2005, were screened using the hospital's computerized pharmacy database to determine if they had received at least 1 qualifying medication: cosyntropin, fludrocortisone, hydrocortisone, or dopamine, epinephrine, or norepinephrine as a vasopressor infusion. RESULTS: Only 58% (95% confidence interval, 47%-69%) of the 81 patients who met criteria for vasopressor-dependent septic shock (VDSS) were evaluated for critical illness-related corticosteroid insufficiency. Forty-seven percent of the 81 patients who met the criteria for VDSS and 49% of the 47 patients who did not meet the criteria for VDSS were treated with corticosteroids. Nearly all (85%; 95% confidence interval, 72%-94%) patients who did not meet the criteria for VDSS received an adrenocorticotropic hormone test. CONCLUSIONS: Treatment and evaluation of critical illness-related corticosteroid insufficiency in critically ill patients at our institution are inconsistent. Many patients with VDSS do not receive either treatment or evaluation for critical illness-related corticosteroid insufficiency, and patients who do not meet the current criteria are being evaluated and/or treated for critical illness-related corticosteroid insufficiency.

Low tidal volume ventilation does not increase sedation use in patients with acute lung injury.

OBJECTIVE: Low tidal volume ventilation is associated with reduced mortality in patients with acute lung injury, yet concerns exist about patient comfort and the levels of sedation and analgesia required during its use. We compared the doses and duration of sedatives and opioid analgesics in patients receiving low vs. traditional tidal volumes at our institution. DESIGN: Secondary analysis of a randomized clinical trial. SETTING: University-affiliated county hospital in Seattle, WA. PATIENTS: Sixty-one patients with acute lung injury enrolled in the National Heart, Lung and Blood Institute's ARDS Network tidal volume trial. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-three patients were randomized to the lower tidal volume arm (6 mL/kg of predicted body weight) and 28 patients were randomized to the higher tidal volume arm (12 mL/kg of predicted body weight). There were no significant differences in the percentage of study days patients received sedatives, opioids, or neuromuscular blockade. When specific study days were examined, there were no significant differences in the proportion of patients receiving benzodiazepines, propofol, haloperidol, and opioids on days 1, 2, 3, and 7 of mechanical ventilation, nor were there differences in the doses of benzodiazepines and opioids on those days. CONCLUSIONS: At our institution, low tidal volume ventilation was not associated with increased dose or duration of sedatives in patients with acute lung injury. Sedation administration should not be considered a barrier to implementing a lung-protective ventilation strategy.