Reducing neuropathies between the 2020 and 2021 Covid-19 surges in a large UK intensive care unit: A quality improvement project.
Covid-19
intensive care
nerve injury
prone positioning
quality improvement
Journal
Nursing in critical care
ISSN: 1478-5153
Titre abrégé: Nurs Crit Care
Pays: England
ID NLM: 9808649
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
19
05
2022
received:
08
02
2022
accepted:
23
07
2022
medline:
31
8
2023
pubmed:
30
8
2023
entrez:
30
8
2023
Statut:
ppublish
Résumé
Peripheral nerve injuries (PNIs) can be acquired by patients in intensive care unit (ICU) who are critically unwell with Covid pneumonitis. Prone position ventilation has been linked to this life-changing complication. To reduce the occurrence and severity of PNIs for patients with Covid pneumonitis requiring prone positioning whilst sedated and ventilated in ICU. This study is a quality improvement project that evolved over the course of the first two surges of Covid pneumonitis admissions within the ICU at the Queen Elizabeth Hospital Birmingham (Surge 1: March 2020-July 2020, 93 prone ventilation survivors; Surge 2: September 2020-May 2021, 309 prone ventilation survivors). Implementation of updated prone positioning guidelines that aimed to reduce the risk of PNI. This was supplemented by face-to-face teaching for ICU professionals. The number of patients who sustained PNI and the severity of such injuries were recorded. During the first surge 21 patients (22.6%) had at least one high grade PNI. During the second surge there were 12 patients (3.9%) sustaining an intermediate or high grade PNI. For PNI patients, there was an increase in the mean proning episodes (6-13) and duration (17.8-18.6 h). This represents an 82% reduction in PNI cases. High grade injuries reduced from 14/21 (66%) to 4/12 (33%). Optimizing the position of patients in the prone position in ICU with Covid pneumonitis may be key in reducing the development of PNI. Changes to pharmacological management may have influenced the results seen in this study. Clinicians working within ICU with acutely unwell patients with Covid pneumonitis should acknowledge the heightened risk of PNI and take relevant steps to reduce the risk of injury acquisition.
Sections du résumé
BACKGROUND
Peripheral nerve injuries (PNIs) can be acquired by patients in intensive care unit (ICU) who are critically unwell with Covid pneumonitis. Prone position ventilation has been linked to this life-changing complication.
AIM
To reduce the occurrence and severity of PNIs for patients with Covid pneumonitis requiring prone positioning whilst sedated and ventilated in ICU.
STUDY DESIGN
This study is a quality improvement project that evolved over the course of the first two surges of Covid pneumonitis admissions within the ICU at the Queen Elizabeth Hospital Birmingham (Surge 1: March 2020-July 2020, 93 prone ventilation survivors; Surge 2: September 2020-May 2021, 309 prone ventilation survivors). Implementation of updated prone positioning guidelines that aimed to reduce the risk of PNI. This was supplemented by face-to-face teaching for ICU professionals. The number of patients who sustained PNI and the severity of such injuries were recorded.
RESULTS
During the first surge 21 patients (22.6%) had at least one high grade PNI. During the second surge there were 12 patients (3.9%) sustaining an intermediate or high grade PNI. For PNI patients, there was an increase in the mean proning episodes (6-13) and duration (17.8-18.6 h). This represents an 82% reduction in PNI cases. High grade injuries reduced from 14/21 (66%) to 4/12 (33%).
CONCLUSIONS
Optimizing the position of patients in the prone position in ICU with Covid pneumonitis may be key in reducing the development of PNI. Changes to pharmacological management may have influenced the results seen in this study.
RELEVANCE TO CLINICAL PRACTICE
Clinicians working within ICU with acutely unwell patients with Covid pneumonitis should acknowledge the heightened risk of PNI and take relevant steps to reduce the risk of injury acquisition.
Identifiants
pubmed: 37644907
doi: 10.1111/nicc.12837
pmc: PMC9538016
doi:
Types de publication
Journal Article
Langues
eng
Pagination
789-799Informations de copyright
© 2022 British Association of Critical Care Nurses.
Références
Cureus. 2021 Oct 21;13(10):e18958
pubmed: 34707947
Arch Phys Med Rehabil. 2018 Apr;99(4):629-634
pubmed: 29122580
PLoS One. 2019 Apr 23;14(4):e0215301
pubmed: 31013287
J Intensive Care Med. 2020 Dec;35(12):1576-1582
pubmed: 32959717
Nat Rev Rheumatol. 2021 Jun;17(6):315-332
pubmed: 33903743
J Hand Surg Am. 2009 Nov;34(9):1682-8
pubmed: 19896011
Crit Care. 2021 Apr 6;25(1):128
pubmed: 33823862
Int J Environ Res Public Health. 2021 Oct 03;18(19):
pubmed: 34639733
J Hand Surg Am. 2018 Oct;43(10):950.e1-950.e6
pubmed: 29678427
Cureus. 2021 Apr 8;13(4):e14374
pubmed: 33987045
JBMR Plus. 2019 Feb 27;3(4):e10172
pubmed: 31044187
Phys Ther. 2021 Jan 4;101(1):
pubmed: 33395478
Radiology. 2021 Mar;298(3):E117-E130
pubmed: 33258748
Crit Care. 2020 Sep 27;24(1):580
pubmed: 32981525
Br J Anaesth. 2020 Dec;125(6):e478-e480
pubmed: 32948295
Cureus. 2021 Sep 20;13(9):e18132
pubmed: 34692341