Articles: intensive-care-units.
-
Randomized Controlled Trial Clinical Trial
Effects of critical care unit noise on the subjective quality of sleep.
Nurse researchers have provided evidence that hospital critical care unit (CCU) noise may put patients at risk for sleep problems. Technological advances in this setting have been described as contributing to this problem. Although data on the negative effects of CCU noise on physiological sleep are available, less attention has been given to self-reports of the subjective quality of sleep following exposure to this stressor. ⋯ Data on the quality of dreams yielded no difference between groups. The results provide support for the hypothesis that CCU sound levels impact negatively on subjective sleep. It was recommended, now that CCU sound levels were isolated in the laboratory as a potential stressor, that future research should attempt to replicate this study in a hospital CCU.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The cost-effectiveness of a special care unit to care for the chronically critically ill.
To assess the relative value of healthcare programs, technologic innovations, and clinical decisions, policymakers are searching for ways to evaluate cost-effectiveness. What constitutes cost-effectiveness and how should it be measured? The authors discuss ways in which the cost-effectiveness of clinical programs can be measured and describes various methods of assessing both costs and effectiveness. Comparison of the cost-effectiveness of a nurse managed special care unit with that of traditional intensive care units illustrates some of these methods.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.
The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. ⋯ The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Premature infant responses to noise reduction by earmuffs: effects on behavioral and physiologic measures.
The continuous high-intensity noise in the neonatal intensive care unit (NICU) is both stressful and harmful for the premature infant. Although some researchers have found evidence that loud noise can cause hearing loss and alter physiologic and behavioral responses, no study to date has investigated the benefits of noise reduction by the use of earmuffs. In this study earmuffs were placed over the premature infants' ears to reduce noise intensity in the NICU while physiologic and behavioral responses were measured. ⋯ When infants wore the earmuffs, they had significantly higher mean oxygen saturation levels and less fluctuation in oxygen saturation. Furthermore, these infants had less frequent behavioral state changes, spent more time in the quiet sleep state, and had longer bouts in the sleep state. It is imperative that NICUs develop aggressive antinoise policies to substantially and consistently reduce noise.
-
Randomized Controlled Trial Clinical Trial
A randomized, double-blind, placebo-controlled trial of selective digestive decontamination in a medical-surgical intensive care unit.
A randomized, double-blind, placebo-controlled trial of selective decontamination of the oropharynx and gastrointestinal tract was conducted on 61 intubated patients in a medical-surgical intensive care unit (ICU) to determine the impact on nosocomial pneumonia, other infections, and emergence of colonization or infection with antibiotic-resistant bacteria. Over 8 months, 30 patients received an oral paste and solution containing polymyxin, gentamicin, and nystatin; 31 patients received a placebo paste and solution. ⋯ There was no difference in infections caused by antibiotic-resistant gram-negative bacilli, although a trend towards more frequent infection with gentamicin-resistant enterococci was found for study patients. Selective decontamination did not appear to be effective in our very ill medical-surgical ICU patients, although the number of patients in our trial was sufficient to detect only a 50% or greater reduction in pneumonia rates.