Search

Purpose In general, sleeping and activity patterns vary between individuals. This attribute, known as chronotype, may affect night shift performance. In the intensive care unit (ICR), night shift performance may impact patient safety. We have investigated the effect of chronotype and social demographics on sleepiness, fatigue, and night shift on the performance of nurses. Methods This was a prospective observational cohort study which assessed the performance of 96 ICU night shift nurses during the day and night shifts in a mixed medical-surgical ICU in the Netherlands. We determined chronotype and assessed sleeping behaviour for each nurse prior to starting shift work and before free days. The level of sleepiness and fatigue of nurses during the day and night shifts was determined, as was the effect of these conditions on psychomotor vigilance and mathematical problem-solving. Results The majority of ICU nurses had a preference for early activity (morning chronotype). Compared to their counterparts (i.e. evening chronotypes), they were more likely to nap before commencing night shifts and more likely to have young children living at home. Despite increased sleepiness and fatigue during night shifts, no effect on psychomotor vigilance was observed during night shifts. Problem-solving accuracy remained high during night shifts, at the cost of productivity. Conclusions Most of the ICU night shift nurses assessed here appeared to have adapted well to night shift work, despite the high percentage of morning chronotypes, possibly due to their 8-h shift duration. Parental responsibilities may, however, influence shift work tolerance., Author(s): Laurens Reinke [sup.1], Yusuf Özbay [sup.1], Willem Dieperink [sup.1], Jaap E. Tulleken [sup.1] Author Affiliations: (1) grid.4830.f, 0000000404071981, Department of Critical Care, University Medical Center Groningen, University of Groningen, [...]

Purpose The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of leadership training on the quality of IDRs in the ICU. Methods A nonrandomized intervention study was conducted in four ICUs for adults. The intervention was a 1-day training session in a simulation environment and workplace-based feedback sessions. Measurement included 28 videotaped IDRs (total, 297 patient presentations) that were assessed with 10 essential quality indicators of the validated IDR Assessment Scale. Participants were 19 intensivists who previously had no formal training in leading IDRs. They were subdivided by cluster sampling into a control group (ten experienced intensivists) and intervention group (nine intensive care fellows). Mann-Whitney U test was used to compare results between control and intervention groups. Results Baseline measurements of control and intervention groups revealed two indicators that differed significantly. The frequency of yes ratings for the intervention group significantly increased for seven of the ten indicators from before to after intervention. The frequency of yes ratings after training was significantly greater in the intervention than control groups for eight of the ten essential quality indicators. Conclusions The leadership training improved the quality of the IDRs performed in the ICUs. This may improve quality and safety of patient care., Author(s): Elsbeth C. M. Ten Have [sup.1], Raoul E. Nap [sup.1], Jaap E. Tulleken [sup.2] Author Affiliations: (1) grid.4830.f, 0000000404071981, Directorate Medical Affairs, Quality and Safety University Medical Center Groningen, [...]

Keywords: atrial fibrillation; amiodarone; magnesium sulphate; intensive care unit; critically ill patients 61 Case ReportEfficacy of Magnesium-Amiodarone Step-Up Scheme in Critically Ill Patients With New-Onset Atrial Fibrillation: A Prospective Observational [...]

Byline: Esther A. P. Bockel (1), Jaap E. Tulleken (1), Anneke C. Muller Kobold (1), Jack J. M. Ligtenberg (1), Tjip S. Werf (1), Rob Spanjersberg (1) Keywords: Endotoxin; Troponin I; Myocardial dysfunction; Tumour necrosis factor-[alpha] (TNF-[alpha]); Interleukin-6 (IL-6); Interleukin-8 (IL-8); Sepsis Abstract: Objective To study the relationship between cytokine levels and cardiac troponin I (cTnI). Design Prospective experimental study. Setting Intensive care unit of a university hospital. Participants Six healthy male volunteers. Interventions Endotoxin, 4 ng/kg, was given as a 1-min intravenous infusion. Measurements and results Circulating cardiac troponin I levels and proinflammatory cytokines tumour necrosis factor-[alpha] (TNF-[alpha]), interleukin-6 (IL-6) and interleukin-8 (IL-8) were analysed at various time points during a 24-h period. TNF-[alpha] appeared in the circulation 30 min after injection (T=0.5 h), reaching peak levels (5,665+-1,910 pg/ml) 2 h after infusion. At T=24 h TNF-[alpha] was still elevated in the circulation compared to T=0. None of the six volunteers had a cTnI value higher than 0.1 ug/l at T=0, 6 h or 24 h. Conclusion The presence of significant amounts of TNF-[alpha], IL-6 and IL-8 in the systemic circulation does not lead to increased levels of cTnI in experimental human endotoxaemia. Author Affiliation: (1) Intensive and Respiratory Care Unit, Department of Internal Medicine , University Hospital Groningen, PO Box 30.001, 9700 RB , Groningen, The Netherlands Article History: Received Date: 02/12/2002 Accepted Date: 27/05/2003 Online Date: 17/07/2003

Summary: Sleep disruption is common among intensive care unit patients, with potentially detrimental consequences. Environmental factors are thought to play a central role in ICU sleep disruption, and so it is unclear why environmental interventions have shown limited improvements in objectively assessed sleep. In critically ill patients, it is difficult to isolate the influence of environmental factors from the varying contributions of non‐environmental factors. We thus investigated the effects of the ICU environment on self‐reported and objective sleep quality in 10 healthy nurses and doctors with no history of sleep pathology or current or past ICU employment participated. Their sleep at home, in an unfamiliar environment ('Control'), and in an active ICU ('ICU') was evaluated using polysomnography and the Richard‐Campbell Sleep Questionnaire. Environmental sound, light and temperature exposure were measured continuously. We found that the control and ICU environment were noisier and warmer, but not darker than the home environment. Sleep on the ICU was perceived as qualitatively worse than in the home and control environment, despite relatively modest effects on polysomnography parameters compared with home sleep: mean total sleep times were reduced by 48 min, mean rapid eye movement sleep latency increased by 45 min, and the arousal index increased by 9. Arousability to an awake state by sound was similar. Our results suggest that the ICU environment plays a significant but partial role in objectively assessed ICU sleep impairment in patients, which may explain the limited improvement of objectively assessed sleep after environmental interventions. [ABSTRACT FROM AUTHOR]

Background: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients.Methods: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated.Results: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients.Conclusion: The agreement between lung ultrasound and auscultation is poor.Trial Registration: NCT02912624. Registered on September 23, 2016. [ABSTRACT FROM AUTHOR]