FAST HUG –

ICU PROPHYLAXIS

PRESENTED BY –
CAPT VISHVABHARTI
 GIVEN A FAST HUG
TODAY?
Improving the safety and quality of
care for our ICU patients
 GIVE A FAST HUG …
• FAST HUG is a mental “checklist” that highlights key aspects
in the general care of the critically ill
• Developed by Jean-Louis Vincent in Belgium
• Highlights 7 evidenced-based best practices for critical care
• A tool used to ensure that 7 essential aspects of patient care
are not forgotten by the ICU team
• Can be applied to all ICU patients
GIVE A FAST HUG…
F ……. early enteral Feeding
A ……. assessment of Analgesia
S …….. assessment of Sedation
T ……. Thromboembolic prophylaxis
H …… Head of bed elevation
U …… stress Ulcer prophylaxis
G ……. Glycemic control
“F” IS FOR FEEDING
 FEEDING
• Nutritional support must be initiated early
• Oral – enteral – parenteral
• Watch for intolerance
• Nutritional requirement – 25 – 30 k cal /kg/day
proteins – 1.5 -2 gm /kg day
• Provide adequate fluid , electrolytes,vitamins,
trace elements as daily requirement & anticipate
abnormal losses
• Prevent overfeeding
BENEFITS OF NUTRITION SUPPORT

• Maintain normal nutritional status

• Provide intracellular substrates
􀂄 Key nutrients in wound healing
􀂄 Maintain physiological function
Eg. . respiratory muscle strength
􀂄 Support immune function
• Reduce septic complications / mortality
 FEEDING

Patients should be fed

ORALLY or ENTERALLY
within 48 hrs
of ICU admission
 ANALGESIA & SEDATION
• Administration of sedation and analgesia is important to:
􀂄 Ensure patient comfort
􀂄 Reduce cardiovascular/ immunologic responses
􀂄 Facilitate care process
􀂄 Minimize harm to staff
• Equally important to assess degree of sedation/ analgesia
􀂄 Respiratory depression can stunt weaning from MV
􀂄 Splinting and ineffective coughing can increase risk of
nosocomial pneumonia
• Must monitor and titrate drugs to standardize assessment
and treatment
 PAIN IN ICU
PAIN LEADS TO STRESS RESPONSE
WHICH CAUSES :-
• Catabolism
• Immune dysregulation
• Hypercoaguable state
• Increased myocardial workload
• Ischemia
PAIN ASSESSMENT TOOLS
Visual Analogue Scale (VAS)
• Behavioural Pain Scale (BPS)

• Validated in ventilated patients

• >5 points indicative of pain
SEDATION ASSESSMENT TOOL
 BARRIERS TO ASSESSMENT

• Time and workload

• Common ICU myths :
􀂄 Sedated patients do not experience
pain
􀂄 Awake patients can and will verbalize
pain
• ICU cultural beliefs :
􀂄 Ventilated patients need to be
 OVERSEDATION
• Predisposes patients to:
• Thromboemboli
• Pressure ulcers
• Gastric regurgitation and aspiration
• VAP
• Sepsis
• Consequences include:
• Difficulty in monitoring neuro status
• Increased use of diagnostic procedures
• Increase ventilator days
• Prolonged ICU and hospital stay
ANALGESIA & SEDATION

ICU Patients should have

Pain & Sedation
Assessed and Documented
at least
every 6 hours
 “T” IS FOR
THROMBOEMBOLIC PROPHYLAXIS
THROMBOEMBOLISM

• Considerable morbidity and mortality

associated with venous thromboembolism
(VTE) in hospitalized patients
• VTE includes both DVT and PE
• VTE is the single most preventable cause of
hospital associated death among medical
inpatients.
ICU Activities – invasive procedures, drugs, immobility
 THROMBOPROPHYLAXİS
Pharmacalogic Therapies
• Heparin, LMWH
Non-pharmacological Therapies
• Pneumatic compression devices (PCD)
• Thromboembolic stockings
• Early ambulation
• Range of motion exercises
24
THROMBOEMBOLIC PROPHYLAXIS

Patients should receive

prophylactic
anticoagulation
OR compression devices
to
prevent DVTs and PEs
 POSITIONING AND VAP
• HOB positioning ≤ 30 degrees during the first 24 hours
of MV is independently associated with increased risk
for VAP
• Elevating the HOB to 30-45° reduces the risk of
aspiration
“ H “ - HEAD OF BED

Patients should be
maintained in a
semi-recumbent position
with head of bed
30 - 45 degrees to prevent
VAP
 “U” is for
Stress Ulcer Prophylaxis
 STRESS ULCER
• Upwards of 75% of all patients in the ICU demonstrate
evidence of stress related mucosal damage
• Stress related mucosal damage can lead to bleeding in
2-6% of cases
• Consequences of GI bleeding include:
- Prolonged hospitalization
- Increased length of stay in the ICU
- Significant mortality
 Prophylaxis against
stress ulceration is a
necessary consideration
in patients in the ICU to
reduce the risk of GI
hemorrhage
 “G” IS FOR
GLYCEMIC CONTROL
 GLYCEMIC CONTROL
• HYERGLYCEMIA - increase the rate of morbidity,
mortality and health care costs
• COMPLICATIONS - decreased wound healing
- increased infection risk
- impaired GI motility
- impaired CV function
- increased risk of polyneuropathy
- increased risk for acute renal failure
GLYCEMIC CONTROL
• Recommended glucose level – 140 - 180 mg/dl
• Monitor patients for signs and symptoms of
hyperglycemia
• Continuous insulin infusions can be initiated in
patients experiencing fluctuations in glucose
levels >180 mg/dL
 TIPS FOR SUCCESS
• Engage all health disciplines in improving best practice care
• Set up a FAST HUG team
• Incorporate FAST HUG reminders into daily patient care-
Checklists, posters, pens, pocket cards
• Assess each patient daily to see if they are receiving each
element of FAST HUG
• Audit practice and feedback to unit staff and physicians to help
close evidence-practice gap
• Celebrate your successes
 CONCLUSION

Give your patient a

“FAST HUG”
(at least) once a day
thanks