High technology and activity levels in the intensive care unit (ICU) lead to elevated and disturbing sound levels. As noise has been shown to affect the ability of patients to rest and sleep, ...continuous sound levels are required during sleep investigations. The aim of this pilot study was to develop a robust protocol to measure continuous sound levels for a larger more substantive future study to improve sleep for the ICU patient. A review of published studies of sound levels in intensive care settings revealed sufficient information to develop a study protocol. The study protocol resulted in 10 usable recordings out of 11 attempts to collect pilot data. The mean recording time was 17.49 +/- 4.5 h. Sound levels exceeded recommendations made by the World Health Organization (WHO) for hospitals. The mean equivalent sound level (LAeq) was 56.22 +/- 1.65 dB and LA90 was 46.8 +/- 2.46 dB. The data reveal the requirement for a noise reduction program within this ICU.
The purpose of this review was to examine the evidence of cardiovascular risk in early bereavement to identify potential risk factors and possible mechanisms for risk that may inform future research ...directions.
A comprehensive search of electronic databases PubMed Medline, CINAHL and PsycINFO, bereavement related textbooks and reviewed reference lists was undertaken on literature related to evidence of increased risk in bereavement. No limits were set on the searches in terms of date or publication type, but only English language articles were selected.
Bereavement represents a time of heightened cardiovascular risk for the surviving spouse. The immediate weeks following bereavement represent the highest risk period with both men and women across all ages. Risk is evident irrespective of the nature of death, expected or unexpected, although higher level of social support at the time of death may be protective. Evidence would suggest that for many, bereavement results in a time of increased psychological stress and potential for altered behavioural health risk factors that in the presence of altered physiological state, may serve as a potential trigger of cardiovascular events, especially in those most at risk.
The findings from this review provide insight into the impact of early bereavement on health and the recognition that bereavement is associated with increased cardiac risk. This recognition should provide an impetus for individuals to act on cardiac symptoms by seeking medical advice and for health care providers to monitor such individuals more closely.
The death of a loved one is recognized as one of life's greatest stresses, with reports of increased mortality and morbidity for the surviving spouse or parent, especially in the early months of ...bereavement. The aim of this paper is to review the evidence to date to identify physiological changes in the early bereaved period, and evaluate the impact of bereavement interventions on such physiological responses, where they exist. Research to date suggests that bereavement is associated with neuroendocrine activation (cortisol response), altered sleep (electroencephalography changes), immune imbalance (reduced T-lymphocyte proliferation), inflammatory cell mobilization (neutrophils), and prothrombotic response (platelet activation and increased vWF-ag) as well as hemodynamic changes (heart rate and blood pressure), especially in the early months following loss. Additional evidence suggests that bereavement interventions have the potential to be of value in instances where sleep disturbance becomes a prolonged feature of complicated grief, but have limited efficacy in maintaining immune function in the normal course of bereavement.
The Six-Minute Walk Test (6MWT) is widely used as an outcome measure in exercise rehabilitation. However, the repeatability of the 6MWT performed at home in survivors of a critical illness has not ...been evaluated.
The purpose of this study was to evaluate, in survivors of a critical illness: (1) the repeatability of the 6MWT performed at home, (2) the effect on estimates of change in functional exercise capacity if only one 6MWT was performed at follow-up assessments, and (3) the relationship between the physical functioning (PF) score of the 36-Item Short-Form Health Survey questionnaire (SF-36) and the 6MWT.
Repeated measures of the 6MWT and SF-36 were obtained.
Eligible participants had an intensive care unit (ICU) length of stay of ≥48 hours and were mechanically ventilated for ≥24 hours. Two 6MWTs and the SF-36 were conducted in participants' homes at weeks 1, 8, and 26 after hospital discharge.
One hundred seventy-three participants completed the study. The participants had a mean age of 57 years (SD=16), a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission of 19 (SD=10), a mean ICU length of stay of 9 days (SD=8), and a mean mechanical ventilation time of 140 hours (SD=137). Of the 173 participants, 110 performed two 6MWTs at weeks 1, 8, and 26. There were significant mean increases in 6-minute walk distance in the second test of 15 m (P<.0001) at week 1, 13 m (P<.0001) at week 8, and 9 m (P=.04) at week 26. If only one 6MWT was performed at weeks 8 and 26, the estimate of change in 6-minute walk distance from week 1 was 19 m less (P<.001) at both weeks 8 and 26. There was a moderate to strong correlation between SF-36 PF score and 6-minute walk distance at each assessment (week 1: r=.62, P<.001; week 8: r=.55, P<.001; and week 26: r=.47, P<.001).
Some study participants were unable to perform a second 6MWT, and these participants may have differed in important aspects of function compared with those individuals who completed two 6MWTs.
In survivors of a critical illness, the 6MWT in the home environment should be performed twice at each assessment to give an accurate reflection of change in exercise capacity over time. The SF-36 PF score was a strong indicator of 6-minute walk distance in early recovery from a critical illness.
To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU.
The ...intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit.
Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group.
An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy.
The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used.
The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.
Early bereavement is associated with increased cardiovascular events. The mechanism, however, has not been well studied. We assessed whether bereavement is associated with an increased heart rate ...(HR) and decreased heart rate variability that might contribute to increased cardiovascular risk. A total of 78 bereaved spouses and parents (55 women and 23 men; aged 34 to 87 years, mean 65) were studied with 24-hour Holter monitoring within 2 weeks of bereavement (acute) and at 6 months. Their findings were compared to those from a nonbereaved reference group (52 women and 27 men) aged 33 to 91 years (mean 63.6). All participants were in sinus rhythm. We assessed the mean HR, atrial and ventricular arrhythmias, and both time and frequency domain heart rate variability measures. Acute bereavement was associated with increased 24-hour HR (mean ± SE, 75.1 ± 1.1 vs 70.7 ± 1.0; p = 0.004) and reduced heart rate variability, as indicated by lower standard deviation of the NN intervals index (median 45.4 vs 49.9, p = 0.017), total power (7.78 ± 0.10 vs 8.02 ± 0.09, p = 0.03), very low frequency (7.23 ± 0.09 vs 7.44, p = 0.046) and low frequency (5.76 ± 0.12 vs 6.16 ± 0.09, p = 0.01). At 6 months, the bereaved had a significantly lower HR (p = 0.001) and increased standard deviation of the NN intervals index (p = 0.02), square root of the mean square of differences of successive intervals (p = 0.045), number of interval differences of successive NN intervals >50 ms divided by the number of NN intervals (p = 0.039), low-frequency power (p = 0.02), and high frequency (p = 0.002) compared to the initial acute levels. In conclusion, the present study, the first to report 24-hour HR monitoring in the early weeks of bereavement, has demonstrated increased HR and altered autonomic function that might contribute to the increased cardiovascular events in early bereavement.
Although there is an increased cardiovascular risk in the immediate weeks following bereavement, the mechanism is not well understood. The aim of this study was to determine whether inflammatory and ...thrombotic changes were present in acute bereavement.
Eighty bereaved spouses or parents were prospectively studied within 2 weeks of bereavement (acute) and at 6 months, and compared to 80 non-bereaved participants. Haemostatic measures were obtained between 8 a.m. and 11 a.m. and processed within 1 h. Compared to non-bereaved participants, those acutely bereaved had a higher neutrophil count (4.34 ± 0.19 vs 3.79 ± 0.15, p = <0.001), von Willebrand factor antigen (132.33 ± 3.6 vs 119.95 ± 3.29, p = 0.02), Factor VIII (1.43 ± 0.06 vs 1.25 ± 0.04, p = 0.02) and platelet/granulocyte aggregates (median 383.0 vs 343.5, p = 0.02). Levels of neutrophils, monocytes, eosinophils, platelet count, platelet/monocyte granulocytes and von Willebrand factor were lower in bereaved at 6 months compared to acutely (all p < 0.05).
Acute bereavement is associated with inflammatory and prothrombotic changes that may contribute to the increased cardiovascular risk with bereavement and provide clues for future preventative strategies.
mckinley s., fien m., riegel b., meischke h., aburuz m.e., lennie t.a. & moser d.k. (2012) Complications after acute coronary syndrome are reduced by perceived control of cardiac illness. Journal of ...Advanced Nursing68(10), 2320–2330.
Aims. To investigate the relationship between anxiety, perceived control and rate of in‐hospital complications after acute coronary syndrome.
Background. Anxiety may be associated with higher risk of complications following acute myocardial infarction; perceived control may moderate this relationship.
Design. Prospective observational study.
Methods. Patients enrolled in a trial investigating delay in seeking treatment for acute coronary syndrome had anxiety measured at enrolment and 3 months using the Brief Symptom Inventory anxiety subscale. The acute coronary syndrome hospital presentations investigated occurred between 2001–2006. Patients with anxiety scores greater than the population norm at both time points were categorized as persistently anxious. Perceived control was measured at enrolment using the Control Attitudes Scale‐Revised. Data were collected from the medical record on in‐hospital complications in patients presenting with acute coronary syndrome within 2 years of enrolment. Chi‐square and t‐tests were used for univariate analyses and multiple logistic regression to identify independent predictors of complications.
Results. Patients (n = 171) were 64% men with mean age 69 years. Ischaemic or arrhythmic complications occurred in 26 patients (15%) with no difference in complication rates between those persistently anxious and others. Important univariate predictors of in‐hospital complications were lower perceived control, diagnosis of acute myocardial infarction, heart failure and higher pulse rate on admission. Low perceived control and diagnosis of acute myocardial infarction were independent predictors of in‐hospital complications in the multiple logistic regression.
Conclusion. Perceived control, but not persistent anxiety, prior to acute coronary syndrome was an important predictor of in‐hospital complications after acute coronary syndrome. Interventions to increase cardiac patients’ perceived control of their cardiac illness may reduce in‐hospital complications after acute coronary syndrome.
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