Intensive Care
A spell in the ICU is no-one’s idea of a holiday, but advances in engineering are helping to make intensive care safer for patients and less stressful for nursing staff. Claire Le Couteur reports on the results of a collaboration between biomedical engineers and an ICU doctor at Christchurch Hospital.
Intensive care is inevitably stressful for patients and staff alike. Patients are admitted acutely ill or injured; they are anxious, traumatised, and in severe pain, and can sometimes be delirious or violent. To manage their symptoms and minimise risk, nurses administer a mixture of pain killers and tranquillisers. Despite their routine use, however, sedation and analgesia for critically ill patients remains one of the most arbitrarily applied treatments in medicine.
Typically, dosing relies on the judgement and experience of intensive care unit (ICU) staff. Nurses “score” a patient’s level of agitation or sedation on the basis of their movement, heart rate, blood pressure and respiration, supplemented with more subjective assessments – “How effective was the dosage last time?” and “How stressed do they appear to be?” Doses are adjusted to produce the desired outcome, which can also vary from nurse to nurse. And then critically ill patients nearly always have reduced levels of consciousness, making it particularly hard to accurately gauge the effects of sedation.
The highly subjective process often has patients cycling between agitated under-sedation and over-sedation. These states are equally undesirable. Under sedation can result in violently anxious patients who are a danger to nursing staff; over sedation is risky for the patient and results in the need for more intervention such as mechanical ventilation, and longer stays in intensive care.
But a small device developed by a group of biomedical engineers and an ICU doctor at Christchurch Hospital may change all this. Richard Dove MIPENZ, Kathryn Greenfield and Dr Geoffrey Shaw have produced a semi-automated controller which takes much of the subjectivity out of sedation by automatically delivering a logarithm-based dosage. The Infuse-Rite promises to standardise the administration of sedation medication, reducing the risk for patients, simplifying nursing, and hopefully reducing costs along the way.
This case study is reproduced with permission from e.nz magazine. Subscriptions to e.nz are discounted for Schools and TENZ members.
