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Reasons and Frequency of Ventilatory Circuit Disconnection in Patients on Artificial Pulmonary Ventilation
Ševčíková, Klára ; Línková, Šárka (advisor) ; Kravcová, Kateřina (referee)
The thesis deals with the reasons for disconnecting the ventilation circuit and the frequency of individual causes. It is part of a broader and more comprehensive study whose common goal is to combat ventilator-associated pneumonia (VAP). The theoretical part of the thesis briefly describes the definition of VAP and its preventive elements. However, it highlights the conflict between manufacturers' recommendations and the results of the latest studies regarding the interval for replacing individual components of the ventilation circuit. Furthermore, it draws attention to the limited and insufficient emphasis placed on this issue both in the theoretical sphere and in clinical practice. The practical part of the thesis presents the results of the conducted observation, whose main objective is to identify the most common cause of ventilation circuit disconnection. The assumption was a high proportion of the frequency of replacing individual circuit components,especiallythe passive heat and moisture exchanger,which was confirmed by the results of the research survey. Another objective was to observe hygiene practices in the care of the ventilation circuit, which had not been fully defined before. Equally important was the establishment of foundations for creatingstandardized procedures and highlighting...
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Scoring system for sputum evaluation assessing specificity and sensitivity
Fidra, Dominika ; Trnková, Ivana (advisor) ; Maláska, Jan (referee)
The aim of this diploma thesis is to create a scoring system in sputum evaluation for general nurses in the intensive care unit. It is conceived as a diagnostic study that assesses the ability of the scoring system to accurately determine the ongoing condition - an infectious inflammatory disease. The collected biological material was compared with the gold standard - microbiology, by two independent persons. The result of the diagnostic study is a verified scoring system, where the color, consistency, admixtures and odor of the biological material of sputum are described for individual point evaluations. The main parameters of the diagnostic test - sensitivity, specificity and predictive value (positive and negative) - were used to verify the scoring system. For normal and pathological values, cut-off values were determined, according to which the value of sensitivity and specificity changed. By plotting the values on a graph and creating a ROC curve, it was found that with a cut off value of 1 and 2 for the first evaluator, the resulting area under the curve (AUC)=0.75. The result represents the scoring system according to the first evaluator as a good and effective test. The research was carried out at the anesthesiology and resuscitation clinic at the University Hospital of Kralovske Vinohrady...
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Influence of early antibiotic treatment on lower airway microbial colonisation in patients receiving mechanical ventilation
Kroupová, Alžběta ; Duška, František (advisor) ; Kukol, Václav (referee)
AJ Introduction: Ventilator-associated pneumonia (VAP) is a significant source of morbidity and mortality among patients undergoing mechanical ventilation. Its development is preceded by colonization of the lower respiratory tract with pathogenic bacteria. The purpose of this study was to investigate how antibiotic therapy administered for non-pulmonary infections affects the colonization of the lower respiratory tract compared to patients not receiving antibiotics. The hypothesis is that antibiotic treatment reduces colonization of the lower respiratory tract but increases the occurrence of multidrug-resistant bacteria. Methods: This was a retrospective observational cohort study conducted on critically ill patients hospitalized at the Department of Anesthesiology and Resuscitation, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady. This study is part of an ongoing project aimed at improving the quality of care and preventing VAP in intensive care unit patients. Patients had to meet certain criteria: they had to be on mechanical ventilation for more than 48 hours, have no pre-existing pulmonary diseases upon hospital admission, and not be immunocompromised. The primary outcome was the difference in the proportion of patients with positive microbiological...
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Prevention and importance of ventilator associated pneumonia in the intensive care
Sekerka, Pavel ; Kolář, Martin (advisor)
Synopsis Ventilation-associated pneumonia (VAP) presents a severe complication in the care for the mechanically-ventilated patient and its importance rises with the increasing number of resistant microorganisms, which causes VAP. VAP increases morbidity and mortality of the patients, prolongs their hospitalization and leads to the increase of direct and indirect treatment expenses. Options of treatment are sometimes difficult, costly and inefficient, thereby the need to prevent the occurance of VAP by employing a set of preventive measures is needed. Employing and enforcing those measures can decrease the incidence of VAP and thus to improve prognosis of the critically-ill patients in the intesive care. The goal of the experimental part of this thesis was to audit the employment of these preventive measures in practice. A survey using questionnaires and observing the situation on KAR FNKV have shown, that some measures are performed correctly, while some present a space for improvement, some are performed incorrectly or not at all.
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Prevention of Complications in Patients with Secured Airways
Trojáková, Miluše ; Heczková, Jana (advisor) ; Srpová, Daniela (referee)
The thesis reviews airway management practices in intubated a tracheostomised patients. Patients requiring mechanical ventilation have their airways secured mostly by endotracheal or tracheostomy tubes. Such patients are in a great risk of developing serious complications. One of the most common is the ventilator-acquired pneumonia (VAP). Currently, VAP represents a major problem not only in the Czech Republic but globally. In the USA, VAP is the most common nosocomial infection and represents 25% of all ICU infections. VAP complications lead to deterioration of the patients' condition, extend the total duration of hospitalization and some present a mortality risk. The VAP mortality rate has been reported to be 20-50%. Moreover, VAP complications lead to an increase in health care costs. The goal of the thesis is the comparison of the state of the art scientific knowledge, clinical guidelines and current clinical practices. The thesis describes the practice in the highly specific nursing aktivity - airway management, using case studies. My research took place at ARO (ICU - intensive care unit). The first case study involves an intubated patient, the second one a patient with the tracheostomy tube. The analysis has shown that the clinical practice guidelines of the ARO department are being followed...
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Nursing care measures in the prevention of ventilator-associated pneumonia
Kukol, Václav ; Heczková, Jana (advisor) ; Feixová, Dagmar (referee)
The thesis is focused on ventilator-associated pneumonia and its possible preventive measures during nursing care. In the theoretical part of the work we have included chapters on nosocomial infections emphasizing on the etiology and epidemiology of ventilator-associated pneumonia and its clinical manifestations. We have analyzed the issues of artificial airway management with a detailed focus on the peculiarities of nursing care of the ventilated patients. There, we focus primarily on the care of the patients oral cavity, respiratory tract and the ventilation circuit. A big chapter is dedicated to preventive measures and to the possibilities of prevention in the nursing practice. The empirical part includes research on preventive measures that are implemented in practice and comparative analysis of the measures between different facilities as well as their compliance to the guidelines. We have also determined the level of VAP awareness and its prevention among the nurses. KEYWORDS nosocomials infections, nursing care, prevention, ventilator-associated pneumonia
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Prevention and importance of ventilator associated pneumonia in the intensive care
Sekerka, Pavel ; Kolář, Martin (advisor)
Synopsis Ventilation-associated pneumonia (VAP) presents a severe complication in the care for the mechanically-ventilated patient and its importance rises with the increasing number of resistant microorganisms, which causes VAP. VAP increases morbidity and mortality of the patients, prolongs their hospitalization and leads to the increase of direct and indirect treatment expenses. Options of treatment are sometimes difficult, costly and inefficient, thereby the need to prevent the occurance of VAP by employing a set of preventive measures is needed. Employing and enforcing those measures can decrease the incidence of VAP and thus to improve prognosis of the critically-ill patients in the intesive care. The goal of the experimental part of this thesis was to audit the employment of these preventive measures in practice. A survey using questionnaires and observing the situation on KAR FNKV have shown, that some measures are performed correctly, while some present a space for improvement, some are performed incorrectly or not at all.
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Nosocomial infection occurrence in patients receiving mechanical ventilation
HOMOLKOVÁ, Lenka
The thesis deals with the most frequent nosocomial infection in the intensive care, the ventilator-associated pneumonia. The main purpose of the thesis was to raise nurses? awareness of this hospital-associated infection. It concentrates particularly on possibilities of prevention from this infection. The thesis consists of a theoretical part and a research part. As the ventilator-associated pneumonia occurs in connection with the mechanical ventilation the introduction to the theoretical chapter deals with the basic terms related to mechanical ventilation. It concentrates on the description of reasons for mechanical ventilation and the ways of its application by nurses during the care of patients receiving mechanical ventilation. The subsequent part deals with nosocomial infections, the factors conditioning the occurrence of nosocomial infections, nosocomial infections in the intensive care and the ways of prevention from these infections. The part following the introduction to mechanical ventilation and nosocomial infections deals with the nosocomial infection associated with continuous mechanical ventilation, the ventilator-associated pneumonia. It describes the disease pathogenesis, factors conditioning its occurrence, diagnostics, treatment and particularly the ways of prevention from this disease. The research part of this thesis contains the results of the quantitative research based on the data gathered by means of an anonymous questionnaire targeted at the nurses at the anesthesiology and resuscitation department and by subsequent monitoring of the nurses. The research also included monitoring the nurses at work. In order to complete the thesis five objectives were outlined and six hypotheses were constructed. The aim of the objectives was to investigate how the nurses care of a tracheostomy and the pulmonary toilet of respiratory tract in patients receiving mechanical ventilation, how they maintain the ventilator and its components. The investigation also concerned the nurses? awareness of the aseptic techniques during the treatment of the respiratory tract and the ventilator. The aim of the last objective was to investigate the ways of prevention from the occurrence of nosocomial infections in patients receiving mechanical ventilation at individual workplaces. Concurrently the following hypotheses were constructed: H1 ? nurses perform the tracheostomy under aseptic conditions; H2 ? nurses perform the pulmonary toilet under aseptic conditions; H3 ? nurses observe the aseptic techniques when maintaining the ventilator; H4 ? nurses are informed about the aseptic techniques during the care of tracheostomy; H5 ? nurses are informed about the aseptic techniques during pulmonary toilet; H6 ? nurses are informed about the ventilator maintenance. On the basis of the knowledge of the issue and the results of the research the output of the thesis was realized in the form of a nursing care standard aimed at the suction of the lower respiratory tract. The second output of this thesis is a poster with ways of prevention from the ventilator-associated pneumonia designed simply to motivate nurses to observe the preventive measures.
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