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Non-reported adverse events during routine nursing procedures in critically ill patients are common: an observational study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0001-6100-189X
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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(English)Article in journal (Other academic) Submitted
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-275168OAI: oai:DiVA.org:uu-275168DiVA: diva2:904117
Available from: 2016-02-18 Created: 2016-01-31 Last updated: 2016-04-04
In thesis
1. Patient safety in the Intensive Care Unit: With special reference to Airway management and Nursing procedures
Open this publication in new window or tab >>Patient safety in the Intensive Care Unit: With special reference to Airway management and Nursing procedures
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 72 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1187
Keyword
intensive care unit, patient safety, nursing procedures, airway managment
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-275170 (URN)978-91-554-9493-3 (ISBN)
Public defence
2016-04-22, Enghoffsalen, Ingång 50, Akademiska sjukhuset, Sjukhusvägen, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-01 Created: 2016-01-31 Last updated: 2016-04-04

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Engström, JoakimReinius, HenrikLarsson, Anders

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