Find a webpage, article, or resource focused on newest technology, trends, or procedures related to cardiovascular health. Blog your opinions and thoughts about what you find on your CI Keys page! Be sure to categorize your blog “Goleta420” so it appears in our course Student Blogs page.
Situation
Patients that have serious illnesses often are admitted to the Intensive Care Unit (ICU). A majority of these patients are also on mechanical ventilation to assist with breathing after experiencing acute respiratory distress syndrome (ARDS) as a result of “either direct or indirect pulmonary injury” (Morton & Fontaine, 2013, p.233). Mechanical ventilation is used to treat a patient that cannot breath on their own. Unfortunately, invasive artificial airways often come with their own complications and high costs.
Background
Mechanical ventilation is well know to cause ventilator associated pneumonia (VAP) and other nosocomial infections. Studies also show that the longer the length of time on a ventilator, the higher it correlates with hospital re-admissions and a draining of ICU resources (Douglas, Daly, Brennan, Gordon & Uthis, 2011). There is evidence based support for getting patients off of ventilators and sedation, as quickly and safely as possible.
Assessment
In the article, “Collaborative practice: development, implementation, and evaluation of a weaning protocol for patients receiving mechanical ventilation,” authors write about how patients are typically weaned off of the ventilator and identified a problem with the fact doctors decided subjectively to wean patients and it is not based on protocols (Grap, Strickland, Tormey, Keane, Lubin, Emerson, & … Sessler, 2003). The doctors would use different parameters and those parameters varied from each doctor and each hospital (Grap, 2003).
Resolution
Grap et al., have focused on using a multidisciplinary approach to wean patients off of their ventilators sooner; this approach utilizes a standardized protocol for weaning the patients (2003). The article researched the medical respiratory ICU (MRICU) protocol which is composed of several scales, guidelines, and assessment tools to help identify if the patient is ready to be weaned (Grap et al., 2003). The article showed that “[p]atients receiving mechanical ventilation have shorter hospital stays and lower costs when a weaning protocol is used” (Grap et al., 2003, p. 455). The article also supported nurses autonomy and working with the respiratory therapist to individualize the weaning process; this encouraged strong communication within the interdisciplinary team (Grap et al., 2003).
Douglas, S., Daly, B., Brennan, P., Gordon, N., & Uthis, P. (2001). Hospital
readmission among long-term ventilator patients. Chest, 120(4), 1278-1286.
Grap, M., Strickland, D., Tormey, L., Keane, K., Lubin, S., Emerson, J., & … Sessler,
C. (2003). Collaborative practice: development, implementation, and
evaluation of a weaning protocol for patients receiving mechanical
ventilation. American Journal Of Critical Care, 12(5), 454-460.
Morton, P. G., & Fontaine, D. K. (2013). Essentials of Critical Care Nursing; a
holistic approach. Philadelphia, PA: Wolters Kluwer.
When it comes to chronic disease, quite often we find the most difficulty not in correcting the pathophysiology of the condition, but in motivating the patient to make real lifestyle changes. Many different forms of education have been tried, some with more success than others, but from what I’ve seen I think that there is a lot to be said for consistency and reaching patients in their daily lives. The article I chose, Text Reminders Help People Lower Blood Pressure, Cholesterol (Shallcross, 2015) demonstrates the power that even simple consistency can have. Today there are hundreds if not thousands of health oriented apps, but most of them require a smartphone and some degree of tech saviness. This article discusses a study recently published in The Journal of the American Medical Association. In this single-blind randomized clinical trial, 710 patients with coronary heart disease were divided into a control (n=358) and intervention group (n=352) (Chow et al., 2015). Each group received the same medical care, but the intervention group also received 4 non-interactive text messages a week focused on education, advice, support, and motivation (Chow et al., 2015). After six months, the intervention group had significant decreases in LDL, SBP, BMI, smoking, and significant increases in activity (Chow et al., 2015).
I find this impressive and exciting. These results are an important reminder that when is comes to patient education, sometimes keeping technology simpler is better. Another important aspect of this model is that text messages are accessible to many people, including those without smartphones. Even in developing countries many people have cell phones that can receive text messages, so this technology could conceivably be applied in such regions. I also appreciate the empowerment aspect of this work. No one was calling these patients to pressure them into changes, they received the messages and independently decided to ignore or take in and apply the content. All in all, I think this study is an important contribution to medicine and hope to see its implications acknowledged.
References
Shallcross, L. (2025). Text Reminders Help People Lower Blood Pressure. National Public Radio.
Retrieved from http://www.npr.org/sections/health-shots/2015/09/22/442518139/text-
reminders-help-people-lower-their-heart-disease-risk
This is the website of the Cottage Heart and Vascular Center. I found it interesting because it explains (in lay terms) all of the procedures (CABG, PCI, Ablation, etc) performed at our local hospital and what patients should expect. The interactive symptom checker, local cottage heart-hotline, and list of heart attack warning signs are all easy to navigate and seem helpful (also for those of us studying for a test!). While in a clinical rotation I once witnessed a PCI in the cardiac cath lab, and beforehand saw the pt give informed consent after the doctor explained the procedure extremely rapidly. The information on this website would have been extremely helpful to the pt before the emergency procedure– but how many people read up on cottage’s heart services when they’re feeling fine? The website also talks about how the hospital goal for all cardiac events is a 90 min or less timeline from door-to-“definitive treatment” since becoming a Cardiac Receiving Center and Level II Trauma Center for Santa Barbara County.
http://www.cottagehealth.org/services/heart-vascular/services-treatments/
Article: Too Much, Too Little Sleep May Harm the Heart
We’ve all heard that proper diet and exercise is crucial to lowering our risk for heart disease. This study focused on another major factor that often doesn’t receive as much attention, sleep. With the American mentality of work hard, play hard it often seems that there isn’t much time left for sleep. In fact, it almost seems that individuals pride themselves on their ability to keep up despite minimal amounts of sleep. While these individuals may feel like they’re living life to its fullest, they are missing out on the major benefits of getting a good nights sleep.
With attempting to balance work, school, and some form of a social and healthy lifestyle I often find that sleep gets thrown by the wayside. Recently it’s become a personal goal of mine to try to get better quality sleep and more of it.
I found this article interesting because it discusses not only the importance of sleep as it relates to cardiovascular health, but the importance of the right amount of sleep.
According to the article, a study of 47,000 participants showed individuals who:
So, as with most things in life, sleep is good in moderation. It looks as though oversleeping may actually be more harmful to your heart than not getting enough sleep!
We do everything on our phones, expect what they were originally meant for, talk. Texting is quick and easy but could improve your health. A study, posted in Journal of American Medical Association, looked to see if semi-personal text messages could reduce LDL, BMI, blood pressure and even smoking status. The participants in the intervention group received 4 texts a week from an automated service and the other group received regular care. In the end, the intervention group, saw a reduction in BMI, blood pressure, LDL and even smoking status. Although this was a fairly small study of 700 participants for only 6 months, I think there is some reliability.
Text messages are seen as personal and a useful form of communication. Texts also allow an automated service to send out messages to a large number of people. It shows increased interest in the patient’s health and can hold them more accountable. I think an additional benefit would be an option to respond to the text messages and get feed back about food choices, exercise ideas and possible list of resources in the community for additional resources.
Healthcare will be forced to keep up with digital communication age and I think texting can make health care information more accessible and convenient for everyone with a cell phone.
Chow, C, et al. Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease. JAMA. 2015.
Did you know that having an illness that requires a prolonged ICU stay, can lead to months of disability after discharge? As patients are grateful for overcoming a critical time in their lives, there is a high probability of having another difficult challenge ahead of them: not being able to function as they had been able to prior to their ICU stay. This may result from ICU delirium which affects 60% to 80% of patients that were on ventilators and 20% to 40% of patients that were not on ventilators (Brummel et al., 2014). In Nashville, Tennessee at St. Thomas Hospital, 126 ICU patients were studied between October 2003 and March 2006 and researchers found an association between the duration of ICU delirium and patients’ post ICU disability (Brummel et al., 2014). During the following year after discharge from the ICU, functional ability to perform activities of daily living (ADLs) were tested and the correlation of a longer period of ICU delirium and decreased ability to perform ADLs was found.
After watching three videos on ICU delirium and reading the article on this study, I agree with Dr. Brummel et al., that treatment of delirium is essential in attempt to prevent months of diminished motor function since performing one’s ADLs is of high importance to most individuals. This article also pointed out another interesting study that showed reduced delirium in ICU patients at risk of atrophy and weakness who received physical and occupational therapy (PT/OT) within the first couple of days while on a ventilator. It appears steps that need to be taken are assessment of ICU delirium, attempt to reduce the duration of ICU delirium, have PT/OT work with patients at risk in the ICU sooner rather than later, and continue to research ways to reduce disability post ICU discharge.
http://www.oapublishinglondon.com/images/html_figures/1301_572.jpg
References
Brummel N E Jackson J C Pandharipande P P Thompson J L Shintani A K Dittus R SGirard T D 2014 Delirium in the Intensive Care Unit subsequent long-term disability among survivors of mechanical ventilation.Brummel, N. E., Jackson, J. C., Pandharipande, P. P., Thompson, J. L., Shintani, A. K., Dittus, R. S.,…Girard, T. D. (2014). Delirium in the Intensive Care Unit subsequent long-term disability among survivors of mechanical ventilation. Crit Care Med, 42(2), 369-377. doi:10.1097/ccm.0b013e3182a645bd 201509211616561221419573
Week 4 Blog Post: Delirium (Janell Nunn)
Briefly summarize your findings. Do you agree with the article? Why or why not? What are the next steps needed? Share your “finds” from your own blog for this week.
This was a very short section of a larger article. It agreed with the article and videos we all read. Stating that the CAM ICU Delirium tool is extremely helpful in catching more cases of delirium. The article discussed adding this and other tools to help prevent long term effects of delirium and was concerned with having these tools added to hospital protocols, especially given the success of the trials (done in four stages at large hospitals in ICUs only).
I agree with the article, mostly due to the evidence presented in the other article we read and the videos. The next steps needed for this article are: getting the CAM ICU added into hospital protocols; putting interventions in place for those identified to have delirium based on these new protocols.
My “Finds” from the reading/videos: This is an issue of which I was entirely unaware. The testimony the patient gave on video was astounding and the quote he gave from his psychiatrist stating that it was as real to him as any Post Traumatic Stress Disorder (PTSD) sufferer from the military or police really made the issue come alive. This is what health care protocol is doing to survivors! It is made clear by the information given, that changes need to be made. Research for changes began back in the 1990s and is finally on its way into practice and needs to be taken seriously and swiftly added into daily best practice.
References:
Landro, L. (2011). Informed patient: changing sedation status quo in the ICU. Health Blog, Wall Street Journal. Retrieved from http://blogs.wsj.com/health/2011/02/15/changing-the-sedation-status-quo-in-the-icu/
Nulles, S. (2008). Improving goal-directed sedation practices and recognition of delirium in the MICU. Critical Care Nurse, 28(2), 11.
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