1 / 14

Reducing the lag…

Reducing the lag…. Critical Care & Tracheostomy Discussion and EBP Group 2008. Evidence. Reducing the lag between published research and the clinical application Hot topics Clinical questions – focus on intubation Example through clinical practice. Research. Clinical Practice.

ankti
Download Presentation

Reducing the lag…

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Reducing the lag… Critical Care & Tracheostomy Discussion and EBP Group 2008

  2. Evidence • Reducing the lag between published research and the clinical application • Hot topics • Clinical questions – focus on intubation • Example through clinical practice Research Clinical Practice

  3. What to do in the case of an extubated patient

  4. Bob • 69 year old male • PMHx: Heart disease, NIDDM, OA • Lives at home with wife • Needs some help with dressing • Admitted to hospital for coronary bypass surgery. • Intubated for 10 days

  5. Endotracheal intubation: Insertion of a tube into the trachea for purposes of anesthesia, airway maintenance, aspiration of secretions, lung ventilation, or prevention of entrance of foreign material into the airway; the tube goes through the nose (nasotracheal i.) or mouth (orotracheal i.) . (http://medical-dictionary.thefreedictionary.com/intubation)

  6. Bob • Bob extubated day 10 • Observed to be coughing with water • Speech Pathology referral requested

  7. Question • In critical care patients, does intubation (ETT) versus non-invasive ventilation result in increased incidence of dysphagia?

  8. Results • No article specifically address question…but…some useful clinical information. • Suggestions of acute changes to swallow function • Increased swallow latency (ETT/none) • Elderly (>65) who premorbidly are functionally impaired are more likely to experience aspiration. • Age is implicated in the recovery of dysphagia • Trauma patients may be at increased risk of aspiration • FEES allow for a rapid objective evaluation

  9. Bob • Commenced on modified diet • Moderately dysphonic • Little change in phonation quality 2 weeks post extubation • ENT review requested

  10. Question • In critical care patients, does intubation affect laryngeal health?

  11. Results • Mucosal ulcerations along posterior-medial aspects, granuloma and erythema most common injuries • Correlation with duration of intubation and laryngeal injury, injuries acquired in first 7 days (dogs) • Early laryngeal changes seen after 24 hours intubation • Prolonged intubation and reintubation correlated with increased occurances of complications • Resolution of symptoms 7 days to 4 weeks • Intraoperative complications – anesthesia

  12. Other clinical benefits • Informs clinical practice • Policy development • Hot topic discussions

  13. Challenges • Getting the question right • Covering the literature • What to do with left over information?? • Reducing the lag

  14. Future directions…light bulb moments

More Related