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2019| October-December | Volume 3 | Issue 4
December 18, 2019
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Structure and organization of intensive care units in a tertiary care hospital of north India: A comparative study against national and international guidelines
Vijaydeep Siddharth, Shakti Kumar Gupta, Sidhartha Satpathy, Sandeep Agarwala, Rakesh Lodha
October-December 2019, 3(4):109-115
Organization of intensive care units (ICUs) have a bearing on the quality of care rendered and outcome of care. Hence, this study was conducted with the aim to examine various ICUs for compliance against the different structural and organizational parameters prescribed by the standard national and international guidelines.
A descriptive and observational study was conducted from June 2011 to September 2012 in neonatal surgery ICU (NSICU), pediatric ICU, and medicine ICU (MICU) at a tertiary care teaching hospital of Northern India. Structural and organizational aspects of each ICU were studied against the Indian and international guidelines prescribed by concerned scientific organizations/bodies. These guidelines were selected in consultation with the domain experts. All parameters were assigned equal weightage, and scoring was done by assigning a score of 0, 5, and 10 to noncompliance, partial compliance, and compliance, respectively. Data were collected through direct observations, perusing hospital records, and unstructured interview of key informants.
NSICU assessment against the two international guidelines revealed the adherence of 42.52% and 37.80% toward different structural and organizational parameters. Similarly, low compliance to organizational and structural parameters were observed in pediatric (national –52.38% and international –49.39%) and MICUs (national –50.52% and international –39.01%). All the three ICUs under study have been created by carving out space from their respective inpatient admission area owing to patient care requirements, hence, does not score well against the structural/spatial parameters.
Overall, low compliance of all three ICUs was observed when compared against the prescribed guidelines for organizational and structural parameters.
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Patient-Ventilator asynchrony: Surveying the Knowledge of respiratory therapists in Saudi Arabia
Alawi Adnan Mohammed
October-December 2019, 3(4):129-137
Patient-ventilator asynchrony (PVA) commonly occurs in critically ill patients, and it is connected with poor health outcomes. To prevent PVA, respiratory therapists (RTs) must have sufficient knowledge regarding respiratory physiology and mechanics and have the ability to understand ventilator graphics and patient signs and symptoms. However, little is known of the respiratory care practitioner's knowledge about PVA. The aim of this study is to assess the ability of RTs to identify and manage PVAs based on their years of experience, previous training, and characteristics of their clinical setting.
A study questionnaire was developed to examine the knowledge of RTs to identify PVA. This pilot survey was reviewed and tested by selected experts in the respiratory care field for appropriateness of questions and accuracy of the content. The final survey consisted of 33 items. This include six items on the respondent's demographic information, four on the previous PVA education, eight on the workplace policy and five ventilator screenshot to measure RTs' knowledge on waveform interpretation. Each screenshot had two open text questions asking about the possible causes and solutions for the identified asynchrony. Data were collected and managed using Qualtrics. Exploratory analysis using descriptive statistics was used to analyze the data. Results: A total of 118 recorded responses were received, and 79 participants completed the full survey. Overall, the ability to identify asynchronies on ventilator graph screenshots was poor. Only two RTs (1.7%) correctly detected all five types of asynchrony, whereas 14 (11.8%) identified four asynchronies, 31 (26.1%) recognized three asynchronies, 24 (20.2%) detected two asynchronies, 12 (10.1%) identified only one asynchrony, and 36 (30.3%) did not recognize any asynchronies. No statistically significant differences regarding previous training, years of experience, and work characteristics were observed.
The overall knowledge regarding the identification of PVA among RTs is poor. Previous training, years of experience, and work characteristics were not an indicator to correctly identify PVAs.
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Evaluation of mechanical ventilators' accuracy in clinical settings: A quality control study
Hajed M Al-Otaibi, Khalid A Ansari, Faraz A Farooqi
October-December 2019, 3(4):123-128
A mechanical ventilator (MV) is one of the most important devices in critical care units. Improper ventilator settings may adversely affect patients' health. The objective of this study is to evaluate the accuracy of volume, pressure, and flow delivered by the ventilators in clinical settings.
Materials and Methods:
Thirty randomly chosen MVs from four randomly selected main hospitals in the eastern province of Saudi Arabia were included in this study. All types of modern intensive care unit ventilators brands along with all versions were targeted. Pressure, volume, and flow were evaluated at two levels by using Fluke Biomedical VT PLUS HF Gas Flow Analyzer.
High-pressure mean was 28.7 ± 4.9 cm H
O and low-pressure mean was 14.6 ± 1.3 cm H
O. 95% limits of agreement (LA
) between the measured and setting in high pressure was −0.74–2.86 cm H
O and −0.114–0.84 cm H
O in low pressure. The mean of volume measurements was 676.9 ± 45.5 ml in high setting and 342.9 ± 24 ml in low setting. In high volume setting, LA
of 104.76–138.05 ml, wherein low volume LA
of 47.7–65.3 ml. High flow mean was 53.4 ± 4.6 lpm with LA
of 3.3–6.8 lpm and low flow mean was 36 ± 3.7 lpm with LA
of 1.87–4.6 lpm.
The present data reveal that MVs in clinical settings have some variations in their performance. The delivered flow and volume might not be accurate as it might be anticipated. These differences should be considered while their use in critically ill patients.
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Presentation of myasthenia gravis crisis in a critically ill patient of corpulmonale
Sanjeev Kumar Singla
October-December 2019, 3(4):138-140
The incidence of myasthenia gravis (MG) is around 15–20/100,000. It can present as respiratory failure known as a myasthenic crisis in old age individuals. This can be precipitated by some underlying processes such as sepsis. As most patients with cor pulmonale are associated with type 2 respiratory failure and some degree of muscle fatigue, in this scenario, the other causes of neuromuscular weakness such as MG can be missed. We report the case of an 80-year-old male known case of type 2 diabetes, hypertension, cor pulmonale, and sepsis who presented with generalized weakness and respiratory failure as the first symptom of MG. As there is limited literature available on MG in cor pulmonale, we aimed to report this study.
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Exploring communities of practice among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia
Sharifa Alsayed, Jennifer de Beer, Tahani Ali Uyoni
October-December 2019, 3(4):116-122
Communities of practices (CoPs) are a process in which workers interact and acquire knowledge from each other at the workplace. This informal knowledge in the workplace can assist professionals to become active knowledge builders with sufficient autonomy regarding specific knowledge or skills required. In addition, this approach that supports informal learning facilitates learning among nurses in the workplace. A cross-sectional descriptive design study was conducted to discover facilitators and barriers that affect the implementation of a CoPs approach. The results show that CoPs seemingly provides a forum for sharing on the job, allowing for successful transition and retention. This and other findings can help in improving and facilitating this approach widely among nurses at the workplace.
This study explored CoP among medical and surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. It also presents the facilitators and barriers in implementing the CoPs approach.
A cross-sectional descriptive design was used. Sixty-seven medical-surgical nurses were conveniently sampled at a military hospital in Jeddah, Saudi Arabia. Data were collected using a structured, validated questionnaire.
Descriptive and inferential statistics were used for data analysis and were presented in frequencies, percentages, and
A total of 62 nurses, mostly females, participated in this study. The mean age of respondents was 30.95 years, and
= 52 (83.9%) had a bachelor's degree in nursing, with
= 26 (41.9%) having between 5 and 10 years of experience in nursing. Most respondents (82.3%) had a clear understanding of what a CoP is. Most respondents
= 40 (64.5%) agreed that they wished to share their knowledge within the community. The top facilitators of a CoP as expressed by respondents were: to deliver solutions for daily problems
= 49 (79%) followed by
= 41 (66.1%) of respondents agreeing that CoP transfer best practices and results in the development of new knowledge
= 30 (48.4%). The most common barrier to a CoP identified within this study was lack of time as expressed by most participants
= 46 (74.2%), followed by a lack of confidence,
= 36 (58.1%) and a fear of not sharing correct information
= 31 (50%).
This study described the facilitators and barriers of CoPs. Furthermore, the study highlighted the critique of CoP from the literature. Despite this critique, CoPs are found to provide a forum for sharing on the job, allowing for successful transition and retention.
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