ABSTRACT
INTRODUCTION: Use of selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) in intensive care patients has been controversial for years. Through regular questionnaires we determined expectations concerning SDD (effectiveness) and experience with SDD and SOD (workload and patient friendliness), as perceived by nurses and physicians. METHODS: A survey was embedded in a group-randomized, controlled, cross-over multicenter study in the Netherlands in which, during three 6-month periods, SDD, SOD or standard care was used in random order. At the end of each study period, all nurses and physicians from participating intensive care units received study questionnaires. RESULTS: In all, 1024 (71%) of 1450 questionnaires were returned by nurses and 253 (82%) of 307 by physicians. Expectations that SDD improved patient outcome increased from 71% and 77% of respondents after the first two study periods to 82% at the end of the study (P = 0.004), with comparable trends among nurses and physicians. Nurses considered SDD to impose a higher workload (median 5.0, on a scale from 1 (low) to 10 (high)) than SOD (median 4.0) and standard care (median 2.0). Both SDD and SOD were considered less patient friendly than standard care (medians 4.0, 4.0 and 6.0, respectively). According to physicians, SDD had a higher workload (median 5.5) than SOD (median 5.0), which in turn was higher than standard care (median 2.5). Furthermore, physicians graded patient friendliness of standard care (median 8.0) higher than that of SDD and SOD (both median 6.0). CONCLUSIONS: Although perceived effectiveness of SDD increased as the trial proceeded, both among physicians and nurses, SOD and SDD were, as compared to standard care, considered to increase workload and to reduce patient friendliness. Therefore, education about the importance of oral care and on the effects of SDD and SOD on patient outcomes will be important when implementing these strategies. TRIAL REGISTRATION: ISRCTN35176830.
Subject(s)
Antibiotic Prophylaxis , Attitude of Health Personnel , Critical Care/methods , Emergency Nursing , Gastrointestinal Tract/microbiology , Oropharynx/microbiology , Physicians , Antibiotic Prophylaxis/psychology , Cross Infection/prevention & control , Decontamination , Health Care Surveys , Humans , Intensive Care Units , Netherlands , Nurse-Patient Relations , Physician-Patient Relations , Surveys and Questionnaires , Treatment Outcome , WorkloadSubject(s)
Dehydration/complications , Fasting/adverse effects , Hypernatremia/etiology , Myelinolysis, Central Pontine/etiology , Acute Disease , Adult , Brain Damage, Chronic/etiology , Civil Rights , Coma/etiology , Drainage , Humans , Hydrocephalus/etiology , Hydrocephalus/surgery , Magnetic Resonance Imaging , Male , Myelinolysis, Central Pontine/diagnosis , Myelinolysis, Central Pontine/therapyABSTRACT
BACKGROUND/AIMS: To investigate the effect of pretreatment with allopurinol on oxidative stress during reperfusion and the role in liver tissue protection in partial liver resections for colorectal cancer metastases confined to the liver. METHODOLOGY: Prospective, randomized, clinical trial, single center, Leiden University Medical Center, The Netherlands. SUBJECTS: Curative partial liver resection of colorectal metastases in 16 patients with or without allopurinol pretreatment, between June 1992 and February 1994. INTERVENTIONS: Partial liver resections with Pringle maneuver, intravenous allopurinol versus no allopurinol. OUTCOME MEASURES: The effect of allopurinol on liver cell damage caused by ischemia/reperfusion studied by measuring malondialdehyde, glutathione, glutathione disulfide, vitamin C, liver enzymes and blood clotting factors in blood samples. Morbidity and mortality were also evaluated. RESULTS: Pretreatment with allopurinol had no significant effect on any of our study parameters. CONCLUSIONS: Because ischemia/reperfusion damage is little in our study, pretreatment with allopurinol is of no value.
