Author Archives: Amy

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Clinical Informationist at EUH Branch Library

Does pre-warming patients prior to surgery affect post-surgical core temperatures?

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Inadvertent Perioperative Hypothermia.  In: Joanna Briggs JBI+Connect, Feb 17, 2011.
Evidence summary on effectiveness of various interventions for preventing hypothermia in patients undergoing surgery. Cites evidence-based guideline (National Collaborating Centre for Nursing and Supportive Care. Clinical practice guideline: the management of inadvertent perioperative hypothermia in adults. April 2008) for evidence that suggests warming patients in the preoperative period may reduce risk for inadvertent perioperative hypothermia. See guideline for specific evidence; Fig. 9 (p. 149) summarizes evidence from two observational studies documenting effect of preoperative temperature on incidence of hypothermia.

CINAHL search on preoperative and warming and (postoperative temperature OR hypothermia)
Search results include several quasi-experimental studies evaluating change in post-operative rates of hypothermia after implementing preoperative warming including:

  • Preprocedure warming maintains normothermia throughout the perioperative period: a quality improvement project.  Hooven K; Journal of PeriAnesthesia Nursing, 2011 Feb; 26 (1): 9-14S
  • A preoperative forced-air warming protocol to maintain postoperative normothermia… ASPAN National Conference.  Sedei J; Journal of PeriAnesthesia Nursing, 2010 Jun; 25 (3): 198
  • The Effects of Forced Air Warming in Preventing Post-Operative Hypothermia.  Ochampaugh, Barbara U.; Glenning, Carol; Journal of PeriAnesthesia Nursing, 2011 Jun; 26 (3): 201

PubMed search: preoperative AND warming identified
Torossian A. Thermal management during anaesthesia and thermoregulation standards for the prevention of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. 2008 Dec;22(4):659-68.
Reviews the literature’s findings on all current methods both passive and active and attempts to institute management guidelines for thermal management.

Reviewed by John Nemeth 4/14

Do any ICUs in the United States use arteriovenous fistulae in implementing continous renal replacement therapy (CRRT)?

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The AACN Procedure Manual for Critical Care, 6th ed., 2011, states that although surgically created AV fistulas had been used in the past for CRRT, they are not recommended for CRRT access because of increased rates of injury, bleeding and infection (p. 1023), and the manual references National Kidney Foundation: KDOQI clinical practice guidelines for vascular access: update 2006, Am J Kidney Dis. 2006; 48:S176-S307.

The manual also references Uchino S, et al. Continuous renal replacement therapy: a worldwide practice survey. Intensive Care Med. 2007;33:1563-70.
Of a cohort of 1006 ICU patients treated with CRRT at 54 ICUs in 23 countries, Table 2 (p. 1566) shows that only 1 patient (0.1%) had continuous arteriovenous hemodialysis as the mode for RCCT.

A search of PubMed for continuous renal replacement therapy and access did not identify any studies published in the United States that specifically described using AVF for the access.

Does screening inpatients for delirium affect hospital length of stay?

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Bottom line:  There are no published experimental studies evaluating the effect of screening inpatients for delirium on the hospital length of stay.

Summary:
Length of stay:  A search of Joanna Briggs and of PubMed and CINAHL using combinations of these concepts–delirium, inpatients, screening, length of stay, outcomes–did not identify any studies of the impact of screening for delirium on length of stay.  There were observational studies documenting that delirium in the hospital is associated with increased length of stay.  See Han (2011), Saravay (2004) and reviews in the PubMed search.  None of these report on effect of screening on length of stay.
Delirium Screening and Assessment.  In:  Joanna Briggs JBIConnect
PubMed:  delirium[mesh] AND (inpatients OR hospitalized patients) AND screening AND length of stay

Clinical outcomes:  None of the papers identifed in the searches describe studies assessing effect of screening for delirium on other clinical outcomes, such as mortality or readmission.  Again, there are observational studies documenting the effect of delirium on these outcomes, i.e., Uthamalingam (2011), Gonzalez (2009) in the search below.
PubMed:  (“delirium/diagnosis”[mesh] OR “delirium/prevention and control”[mesh]) AND (inpatients OR hospitalized patients) AND screening AND (outcomes OR mortality OR readmission)

What are the benefits and risks of ultrafiltration in managing patients with decompensated heart failure and is there evidence of this procedure being performed on a cardiac step down unit?

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DynaMed includes information about ultrafiltration in the Acute Heart Failure article.

For the outcome of readmission rate:
DynaMed references ACC/AHA 2009 practice guideline recommending use in patients with refractory congestion. Evidence suggests that ultrafiltration may be associated with reduction in hospital readmission. For a summary of evidence, in the DynaMed article, use links on left side of page – Treatment section>Other management>ultrafiltration.  For details of the evidence, including cited studies see 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults.

For the outcome of length of stay:
A search of PubMed’s Clinical Queries (Therapy filter, heart failure AND length of stay AND ultrafiltration) retrieved 2 RCTs (Hanna, 2012 and Costanzo, 2005) that included length of stay as an outcome. Both studies reported evidence that ultrafiltration may be associated with reduction in length of stay. See individual studies for details on population size and other aspects of the methodology.

For the outcome of kidney function:
Revising the PubMed Clinical Queries to  Therapy/narrow filter, heart failure AND ultrafiltration AND (kidney function OR renal function OR creatinine)  Retrieves studies and reviews discussing kidney function. If there are other actual markers that would be used to measure renal function, those can be added to the Clinical Query.

Use in cardiac step down units:
Searches of PubMed (“step down” OR “progressive care”) AND ultrafiltration AND heart failure and CINAHL (step down OR progressive care) AND heart failure, did not identify any studies specifically discussing ultrafiltration on step down units.

For risks PubMed Clinical Queries for Therapy/Broad filter, heart failure AND (adverse effects OR risk) AND ultrafiltration. There are reviews of evidence by Freda (2011) and Dandamudi (2011) and a retrospective analysis (Flythe, 2011) of data from an RCT to examine morbidity and mortality.  These results include systematic reviews as well.

What is the evidence on the risks of transporting patients within the hospital during shift change?

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Intra-hospital transport: clinician information. In: JBI+Connect
Includes some useful references discussing factors associated with risk and safety.

PubMed
(“Patient Transfer”[MAJR]) AND shift AND (risk OR error* OR incident* OR safety)

Pezzolesi (2010) looks to be the most relevant. It discusses percentage of incidents that occurred during shift change.

CINAHL
(MH “Transfer, Intrahospital”) AND shift AND (risk OR incident* OR error* OR safety)

DId not see any studies specifically examining shift change and transport problems, but there are several articles discussing patient safety in the transport process. Those articles may reference other evidence.

What are the considerations for postoperative care in patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC)?

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Bottom line:  The implications of cytoreductive surgery and HIPEC on postoperative care include prevention of infection, nutritional support and support and education for devices or other procedures that often accompany this procedure.

Dunn D. Surgical Treatment of Patients With Peritoneal Surface Malignancy: Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy.  J Wound, Ostomy and Continence Nurs. 2010; 37(4): 379-85.
Review of cytoreductive surgery and HIPEC, as well as factors to consider in providing postoperative care to these patients, including prevention of surgical site infection, maintenance and education for patient/family on devices, such as drains, nutritional support, and pain control.

 

What is the evidence regarding use of yoga or aromatherapy with post-operative patients?

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Bottom line:  There are a number of experimental studies, mostly about use of aromatherapy to relieve pain.  Results from 2 RCTs indicate that aromatherapy is associated with improvement in postoperative pain and nausea.  However, other studies provide conflicting data.

Here are references from a PubMed search of the question concepts:
postoperative patients
aromatherapy
yoga
postoperative complications, postoperative pain

(postoperative care OR postoperative complications OR postoperative pain) AND (aromatherapy OR yoga) Limit: English

Here are references to the randomized trials on aromatherapy