Quality Improvement in an Anaesthesiology and Intensive Care Unit Through Pain Assessment and Control.

The aim of the study is to determine whether the assessment of postoperative pain and timely measures to control it improve the quality of medical care in intensive care units (ICUs). To develop an improvement model with a focus on pain assessment and control. 151 patients were included in the study, divided into two groups: a retrospective group (RG)-60 patients and a prospective group (PG)-91 patients. A multimodal approach to pain control was applied to all patients. We administered the Critical Care Pain Observational Tool (CPOT) to PG upon admission to the ICU. Visual analog scale (VAS) for pain assessment was used in all non intubated patients in 6 hours intervals. In the PG, а model for improvement was applied using a PDSA (Plan, Do, Study/ Check, Act) cycle. The following indicators have been used: process, outcome, and balancing indicators. A survey of the PG was also conducted. The developed Model of improvement increased the VAS score reporting success rate from 40 to 95%, which allowed significantly better pain control. In PG the registered CPOT score was 1.71 ± 0.73. 90% of patients in PG have an average VAS score below 5 after the improvement model, while in RG-50% of patients, which is statistically significant (P < 0.001). There was no statistically significant difference in balancing indicators between the two groups. Conclusion: The conducted survey confirmed the positive effect of the model. Quality improvement in the ICU depends on accurate assessment of postoperative pain and timely and adequate treatment.

Contrast-enhanced Chest Ultrasound in the Control of Transthoracic Tru-cut Needle Biopsies: A Case Report.

INTRODUCTION: The current article presents a clinical case of ultrasound controlled transthoracic tru-cut needle biopsy of a small metastatic lesion in the left lung, performed with contrast-enhanced ultrasonography (CEUS). The following case demonstrates a real-time interventional manipulation of a very small lesion, which was done under local anesthesia, with a minimal invasion to the patient. CASE PRESENTATION: A 72-year-old woman is presented, hospitalized for a left-sided pleural effusion with bilateral, multiple nodulеs of different sizes in the lungs. Thoracentesis revealed data for atypical cells in the pleural fluid. The CT scan suspected a probable neoplastic process, but the subsequently performed fiberbronchoscopy couldn't prove the existence of the same. The final diagnosis was established after ultrasound controlled transthoracic tru-cut needle biopsy of a pulmonary lesion with the application of a contrast medium. CONCLUSION: The CEUS allows precise detection of the metastatic area because of its unique perfusion characteristics and ability to remain hypocontrasted after the application of the contrast medium sulfur hexafluoride. The persistence of a concomitant left-sided pleural effusion is used as an ultrasound window during the performance of the manipulation, with the successful verification of the pathology as primary pulmonary adenocarcinoma. By the application of this minimally invasive manipulation, an accurate final histological result was obtained.