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Patient safety in the Intensive Care Unit: With special reference to Airway management and Nursing procedures
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
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 [en]
intensive care unit, patient safety, nursing procedures, airway managment
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-275170ISBN: 978-91-554-9493-3 (print)OAI: oai:DiVA.org:uu-275170DiVA: diva2:907700
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
List of papers
1. Pharyngeal oxygen administration increases the time to serious desaturation at intubation in acute lung injury: an experimental study
Open this publication in new window or tab >>Pharyngeal oxygen administration increases the time to serious desaturation at intubation in acute lung injury: an experimental study
2010 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 14, no 3, R93- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Endotracheal intubation in critically ill patients is associated with severe life-threatening complications in about 20%, mainly due to hypoxemia. We hypothesized that apneic oxygenation via a pharyngeal catheter during the endotracheal intubation procedure would prevent or increase the time to life-threatening hypoxemia and tested this hypothesis in an acute lung injury animal model. METHODS: Eight anesthetized piglets with collapse-prone lungs induced by lung lavage were ventilated with a fraction of inspired oxygen of 1.0 and a positive end-expiratory pressure of 5 cmH2O. The shunt fraction was calculated after obtaining arterial and mixed venous blood gases. The trachea was extubated, and in randomized order each animal received either 10 L oxygen per minute or no oxygen via a pharyngeal catheter, and the time to desaturation to pulse oximeter saturation (SpO2) 60% was measured. If SpO2 was maintained at over 60%, the experiment ended when 10 minutes had elapsed. RESULTS: Without pharyngeal oxygen, the animals desaturated after 103 (88-111) seconds (median and interquartile range), whereas with pharyngeal oxygen five animals had a SpO2 > 60% for the 10-minute experimental period, one animal desaturated after 7 minutes, and two animals desaturated within 90 seconds (P < 0.016, Wilcoxon signed rank test). The time to desaturation was related to shunt fraction (R2 = 0.81, P = 0.002, linear regression); the animals that desaturated within 90 seconds had shunt fractions >40%, whereas the others had shunt fractions <25%. CONCLUSIONS: In this experimental acute lung injury model, pharyngeal oxygen administration markedly prolonged the time to severe desaturation during apnea, suggesting that this technique might be useful when intubating critically ill patients with acute respiratory failure.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-130374 (URN)10.1186/cc9027 (DOI)000283781800052 ()20497538 (PubMedID)
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2017-12-12Bibliographically approved
2. Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering
Open this publication in new window or tab >>Maintenance of Airway Pressure During Filter Exchange Due to Auto-Triggering
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2014 (English)In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 59, no 8, 1210-1217 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Daily routine ventilator-filter exchange interrupts the integrity of the ventilator circuit. We hypothesized that this might reduce positive airway pressure in mechanically ventilated ICU patients, inducing alveolar collapse and causing impaired oxygenation and compliance of the respiratory system. METHODS: We studied 40 consecutive ICU subjects (P-aO2/F-IO2 ratio <= 300 mm Hg), mechanically ventilated with pressure-regulated volume control or pressure support and PEEP >= 5 cm H2O. Before the filter exchange, (baseline) tidal volume, breathing frequency,end-inspiratory plateau pressure, and PEEP were recorded. Compliance of the respiratory system was calculated; F-IO2, blood pressure, and pulse rate were registered; and P-aO2, P-aCO2, pH, and base excess were measured. Measurements were repeated 15 and 60 min after the filter exchange. In addition, a bench test was performed with a precision test lung with similar compliance and resistance as in the clinical study. RESULTS: The exchange of the filter took 3.5 +/- 1.2 s (mean +/- SD). There was no significant change in P-aO2 (89 +/- 16 mm Hg at baseline vs 86 +/- 16 mm Hg at 15 min and 88 +/- 18 mm Hg at 60 min, P = .24) or in compliance of the respiratory system (41 +/- 11 mL/cm H2O at baseline vs 40 +/- 12 mL/cm H2O at 15 min and 40 +/- 12 mL/cm H2O at 60 min, P = .32). The bench study showed that auto-triggering by the ventilator when disconnecting from the expiratory circuit kept the tracheal pressure above PEEP for at least 3 s with pressure controlled ventilation. CONCLUSIONS: This study showed that a short disconnection of the expiratory ventilator circuit from the ventilator during filter exchange was not associated with any significant deterioration in lung function 15 and 60 min later. This result may be explained by auto-triggering of the ventilator with high inspiratory flows during the filter exchange, maintaining airway pressure. (ISRCTN.org registration ISRCTN76631800.)

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-216400 (URN)10.4187/respcare.02892 (DOI)000349199900007 ()24282318 (PubMedID)
Available from: 2014-01-21 Created: 2014-01-21 Last updated: 2017-12-06Bibliographically approved
3. Non-reported adverse events during routine nursing procedures in critically ill patients are common: an observational study
Open this publication in new window or tab >>Non-reported adverse events during routine nursing procedures in critically ill patients are common: an observational study
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(English)Article in journal (Other academic) Submitted
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-275168 (URN)
Available from: 2016-02-18 Created: 2016-01-31 Last updated: 2016-04-04
4. Lung complications in intensive care treated patients with pelvis fractures - common but probably not fatal: a retrospective cohort study
Open this publication in new window or tab >>Lung complications in intensive care treated patients with pelvis fractures - common but probably not fatal: a retrospective cohort study
Show others...
(English)Article in journal (Other academic) Submitted
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-275169 (URN)
Available from: 2016-02-18 Created: 2016-01-31 Last updated: 2016-04-04

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