Aim: The main objective was to determine how hospitalized patients subjectively perceive sleep disturbances. The study also assessed the influence of selected factors (physiological, physical, environmental, and psychological) and clinical and demographic variables on sleep disruption. Design: A multicenter descriptive study. Methods: Conducted in seven Czech hospitals from February to May 2023, the study included 397 patients in general wards. Data were collected using a modified questionnaire on sleep disturbances, and the results were analyzed using non-parametric statistical tests. Results: The sample comprised 193 males (48.6 %) and 204 females (51.4%). Females reported more sleep disturbances than males (p = 0.023). Psychological and physical factors had a greater impact on females. Younger patients reported poorer sleep quality (p = 0.015). Pain was the strongest clinical factor that negatively affected sleep (Ra = 0.730). Environmental factors were the leading cause of sleep disturbance in patients (Ra = 0.836). The variability associated with all the factors studied (environmental, psychological, physiological, and physical) accounted for 97.6% of the total variability in sleep disturbance. Conclusion: Females and younger patients experienced more sleep disturbance. Pain and environmental factors were the primary causes of disrupted sleep. Differences were noted in the factors affecting sleep between genders.
- MeSH
- analýza krevních plynů MeSH
- hypoxie diagnóza MeSH
- lidé MeSH
- respirační insuficience * diagnóza epidemiologie patofyziologie terapie MeSH
- resuscitace metody MeSH
- sepse * etiologie patofyziologie terapie MeSH
- syndrom dechové tísně diagnóza patofyziologie terapie MeSH
- umělé dýchání klasifikace škodlivé účinky MeSH
- vyhodnocení orgánové dysfunkce MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
This observational retrospective study aimed to analyze whether/how the spectrum of bacterial pathogens and their resistance to antibiotics changed during the worst part of the COVID-19 pandemic (1 November 2020 to 30 April 2021) among intensive care patients in University Hospital Olomouc, Czech Republic, as compared with the pre-pandemic period (1 November 2018 to 30 April 2019). A total of 789 clinically important bacterial isolates from 189 patients were cultured during the pre-COVID-19 period. The most frequent etiologic agents causing nosocomial infections were strains of Klebsiella pneumoniae (17%), Pseudomonas aeruginosa (11%), Escherichia coli (10%), coagulase-negative staphylococci (9%), Burkholderia multivorans (8%), Enterococcus faecium (6%), Enterococcus faecalis (5%), Proteus mirabilis (5%) and Staphylococcus aureus (5%). Over the comparable COVID-19 period, a total of 1500 bacterial isolates from 372 SARS-CoV-2-positive patients were assessed. While the percentage of etiological agents causing nosocomial infections increased in Enterococcus faecium (from 6% to 19%, p < 0.0001), Klebsiella variicola (from 1% to 6%, p = 0.0004) and Serratia marcescens (from 1% to 8%, p < 0.0001), there were significant decreases in Escherichia coli (from 10% to 3%, p < 0.0001), Proteus mirabilis (from 5% to 2%, p = 0.004) and Staphylococcus aureus (from 5% to 2%, p = 0.004). The study demonstrated that the changes in bacterial resistance to antibiotics are ambiguous. An increase in the frequency of ESBL-positive strains of some species (Serratia marcescens and Enterobacter cloacae) was confirmed; on the other hand, resistance decreased (Escherichia coli, Acinetobacter baumannii) or the proportion of resistant strains remained unchanged over both periods (Klebsiella pneumoniae, Enterococcus faecium). Changes in pathogen distribution and resistance were caused partly due to antibiotic selection pressure (cefotaxime consumption increased significantly in the COVID-19 period), but mainly due to clonal spread of identical bacterial isolates from patient to patient, which was confirmed by the pulse field gel electrophoresis methodology. In addition to the above shown results, the importance of infection prevention and control in healthcare facilities is discussed, not only for dealing with SARS-CoV-2 but also for limiting the spread of bacteria.
- Publikační typ
- časopisecké články MeSH
Aim: The study compared two instruments for detecting delirium, the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) as a reference method. Design: Prospective observational study. Methods: The study included 126 consecutive patients staying in the intensive care unit (ICU) for more than 24 hours. The diagnostic properties of both questionnaires and agreement between them were studied and compared. Additionally, the two tests were used to assess the relationship between selected patient parameters and the presence of delirium. Results: There was a high level of agreement between the CAM-ICU and ICDSC, as expressed by Cohen's κ of 0.829 (95% CI: 0.821-0.838). Cronbach's α assessing the internal consistency of a Czech version of the CAM-ICU and ICDSC was 0.903 and 0.865, respectively. The CAM-ICU had 85.5% sensitivity (95% CI: 84.6-91.8) and 94.1% specificity (95% CI: 92.4-95.5); the ICDSC (cut-off ≥ 4) had 90.6% sensitivity (95% CI: 87.0-93.5) and 89.0% specificity (95% CI: 86.8-91.0). Conclusion: Both compared diagnostic instruments, the CAM-ICU and ICDSC, appear to be adequate and usable. When compared with the CAM-ICU as a reference method, the ICDSC showed similar results and a good level of agreement.
- Klíčová slova
- Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), delirium, Intensive Care Delirium Screening Checklist (ICDSC), intensive care unit (ICU),
- MeSH
- delirium * diagnóza ošetřování terapie MeSH
- mechanické ventilátory MeSH
- ošetřovatelská péče o pacienty v kritickém stavu MeSH
- pooperační delirium MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).
Péče o pacienty s covid-19 a jejich extrémní počty představovaly nebývalou výzvu pro systém intenzivní péče ve zdravotnických zařízeních napříč celou Českou republikou, která byla pandemií onemocněním novým typem koronaviru SARS-CoV-2 obzvlášť postižena. Skokové navýšení potřeby intenzivní péče přineslo nadlimitní zátěž pro lůžkové a personální kapacity. Pro těžký a kritický průběh onemocnění covid-19 je patognomická bilaterální pneumonie s akutním hypoxemickým respiračním selháním. Terapie covid-19 v intenzivní péči je primárně symptomatická a spočívá v podpoře selhávajících respiračních funkcí, která poskytuje čas nutný k jejich zotavení a reparaci plic. Agresivita a komplexnost respirační podpory se odvíjí od tíže selhání a sahá od prosté oxygenoterapie, přes neinvazivní podporu, umělou plicní ventilaci (UPV), až po mimotělní náhradu plic. Specifická terapie covid-19 je naproti tomu cílená přímo proti viru SARS-CoV-2, či má modulovat odpověď organismu na něj. Primární, virem indukované plicní poškození se může sekundárně komplikovat koinfekcí či superinfekcí, nejčastěji bakteriální, které zvyšují tíži a smrtnost onemocnění. Antiinfekční terapie má tudíž pro prognózu a osud pacientů s covid-19 v intenzivní péči zásadní význam. Mezi nozokomiálními infekcemi komplikujícími covid-19 jsou zvlášť důležité a problematické tzv. ventilátorové pneumonie (vzniklé u pacientů na umělé plicní ventilaci) a s nimi související problematika bakteriální rezistence a racionální antibiotické politiky.
Treatment of COVID-19 patients and their extreme numbers represented an unprecedented challenge for the intensive care system in healthcare facilities throughout the Czech Republic, a country particularly affected by the new coronavirus SARS-CoV-2 pandemic. A steep increase in the need for intensive care placed an excess burden on bed and staff capacity. For a severe and critical course of COVID-19, bilateral pneumonia with acute hypoxemic respiratory failure is pathognomonic. In the intensive care setting, COVID-19 therapy is primarily symptomatic, supporting failing respiratory function to gain time needed to restore it and to repair the lungs. The aggressiveness and comprehensiveness of respiratory support depend on the severity of failure, ranging from simple oxygen therapy, to non-invasive support and mechanical ventilation, to extracorporeal support. By contrast, specific COVID-19 therapy is directly targeted against SARS-CoV-2 or modulates the organism’s response to the virus. Primary, virus-induced lung injury may be secondarily complicated by coinfection or superinfection, most commonly bacterial, increasing the severity and lethality of the disease. Therefore, anti-infective therapy is crucial for the prognosis and outlook of intensive care COVID-19 patients. Among nosocomial infections complicating COVID-19, ventilator-associated pneumonia (developing in mechanically ventilated patients) is particularly important and challenging, and so are issues related to bacterial resistance and rational antibiotic therapy.
Introduction: It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. Objective: The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. Methods: A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. Results: The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. Conclusion: The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.
- Publikační typ
- časopisecké články MeSH
Kaudální blokáda je dlouho známá a dobře prostudovaná technika neuroaxiální anestezie využívaná rutinně v dětské anestezii. V dospělé populaci je její použití méně časté – uplatnění nachází především v algeziologii. Detailnější znalosti anatomie a především nástup ultrazvukové navigace však v posledních letech vedou k hojnějšímu využívání této techniky v perioperační péči také u dospělých. Ultrazvukově navigovaná kaudální blokáda představuje i u této skupiny pacientů jednoduchou, bezpečnou a spolehlivou metodu využitelnou jak v anestezii, tak v léčbě akutní pooperační bolesti. V přehledovém článku jsou popsány anatomické aspekty kaudální blokády, technika provedení se zaměřením na ultrazvukovou navigaci a možnosti využití v perioperační péči u dospělých.
Caudal block is a well-known and thoroughly studied technique of neuraxial anaesthesia routinely performed in paediatric anaesthesia. In adults, however, this method has been used mostly in chronic pain management. Due to more detailed understanding of anatomy and the routine use of ultrasound guidance, caudal block has recently been reintroduced into perioperative care in adults. It is now considered a simple, safe and reliable technique for both anaesthesia and postoperative analgesia in this group of patients. This review describes the anatomy and technical aspects with a focus on ultrasound guidance as well as suitable applications of this block in the perioperative setting in adults.
- MeSH
- dospělí MeSH
- epidurální prostor anatomie a histologie účinky léků MeSH
- intervenční ultrasonografie MeSH
- kaudální anestezie * metody přístrojové vybavení MeSH
- lidé MeSH
- lumbosakrální krajina anatomie a histologie MeSH
- nervová blokáda metody MeSH
- perioperační péče * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
