Driving pressure during routine ventilation in the ICU: Is the ICU-team as driven as they should be?

PURPOSE: To evaluate the effect of structured staff training on the respiratory support provided. MATERIALS AND METHODS: Staff training with emphasis on the applied DP in mechanical ventilation was provided during one year. After completion of staff training, the effect was prospectively evaluated in patients who were continuously mechanically ventilated in a controlled mode for at least 6 h starting from admission. Pressure difference (Pdiff = Ppeak - PEEPtot) in the baseline period, as a derivative of the driving pressure, was compared with two evaluation periods from 0 to 6 months and 6-12 months (i.e. follow-up) after completion of the training. RESULTS: At analysis 248 patients met the inclusion criteria. In the baseline period Pdiff was not lung protective (> 15 cm H2O) in 39% of cases. In the first follow-up period this decreased to 25% of cases and further dropped to 17% in the second follow-up period. This was a relative decrease of 56% compared to the training period. At the end of evaluation the proportion of patients with a safe Pdiff had gradually increased from 58% during training to 82% (χ2 = p 0.005). CONCLUSIONS: These results suggest that ICU staff training could lead to more adequate respiratory support provided during controlled mechanical ventilation.

Thirst in adult patients in the intensive care unit: protocol for a scoping review.

INTRODUCTION: Thirst is one of the most bothersome symptoms experienced by intensive care unit (ICU) patients. Effective diagnosis and management of thirst in the ICU is essential, particularly as patients are less sedated than previously and more aware of this problem. Currently, no overview of publications on thirst identification and management in ICU patients exists. The scoping review will address the broad question 'What is known about thirst as a symptom in adult critically ill patients?' It aims to provide an overview of the causes and risk factors, diagnosis and measurement, the symptom dimensions and its interaction with other symptoms, and thirst management. METHODS AND ANALYSIS: The review will follow the Joanna Briggs Institute methodology framework to guide the process and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Methods include: defining the review questions, eligibility criteria, concepts of interest and context; and outlining the search strategy, study selection process, data extraction and analysis. PubMed, MEDLINE, EMBASE and CINAHL will be searched from inception to April 2022. ETHICS AND DISSEMINATION: Ethical approval is not required, as the scoping review will synthesise information from available publications. The scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with ICU support groups and the critical care professional community.

Measuring thirst distress of patients in the intensive care unit.

BACKGROUND: Thirst is one of the most intense and distressing symptoms experienced by patients in the intensive care unit (ICU), and no validated measurement tools exist. Validating a thirst measurement tool for the ICU population could be a first step in gaining a better understanding of thirst in ICU patients and aid the development and implementation of strategies regarding the prevention and control of thirst. AIM: The objective of this study was to determine the validity and reliability of the "Thirst distress scale for patients with heart failure (TDS-HF)" in measuring thirst distress in adult ICU patients. METHODS: Content validity was established by an expert panel consisting of ICU nurses, intensivists and five ICU patients. Concurrent validity, known-groups validity and internal consistency were determined in a consecutive sample of 56 awake and oriented ICU patients with a median age of 70 years (IQR: 57-74). RESULTS: Content validity of the TDS-HF in the ICU population was low, with item-content validity indexes between 0.25 and 0.75. Concurrent validity was high as Spearman's correlation between TDS-HF and the numeric rating score (0-10) for thirst distress was 0.71. Internal consistency was high (Cronbach's alpha 0.78). When comparing groups, only higher blood urea nitrogen was significantly related to higher scores on the TDS-HF (P = .003). CONCLUSION: The TDS-HF has high concurrent validity and reliability in measuring thirst distress in ICU patients. Nevertheless, questions remain regarding the applicability and content validity of the scale, which should be further explored before the TDS-HF can be used in the ICU. RELEVANCE FOR CLINICAL PRACTICE: The TDS-HF can be used to explore thirst distress and to evaluate interventions. Individual items of the scale can be used to explore the nature of thirst distress in individual patients.

Awareness and Management of Dysphagia in Dutch Intensive Care Units: A Nationwide Survey.

Dysphagia is a common problem in the intensive care unit (ICU), yet no national guidelines on dysphagia prevention, screening, and management exist. We performed a survey to learn which strategies are commonly being used in Dutch ICUs. A survey was developed based on current literature and experts' opinions. It comprised questions regarding hospital and ICU characteristics, perceived prevalence and importance of dysphagia, screening strategies, modalities used to prevent aspiration, and interventions used to improve swallowing function. It was sent to all 90 non-pediatric ICUs in The Netherlands. 67 of 90 addressed ICUs (74%) replied to our survey. A median relevance score of 4 (IQR 4-5) out of 5 was given to the topic of dysphagia. In 22% and 45% of ICUs, patients were always screened for dysphagia after extubation or tracheotomy, respectively. The water swallow test was always part of the work-up in 88% of ICUs. Fiberoptic endoscopic evaluation of swallowing was used occasionally in 60% of ICUs, versus videofluoroscopic swallowing study in 25%. In 49% of ICUs, no standardized active rehabilitation protocol for dysphagia existed. In the remaining 51%, swallowing exercises were always part of standard rehabilitation, occasionally supplemented by electrical stimulation or surface-EMG biofeedback training in 6 and 10%, respectively. Most Dutch ICUs do not regularly screen for dysphagia and almost half do not seem to have a diagnostic, treatment, or rehabilitation protocol, despite recognizing it as a significant and relatively frequent problem in the ICU with potentially serious patient consequences.