Heart & lung : the journal of critical care
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Comparative Study
Caregiver burden and outcomes of caregiving of spouses of patients who undergo coronary artery bypass graft surgery.
Patients who undergo coronary artery bypass graft surgery often rely on spouses for care during recovery. Although often meaningful, caregiving may be stressful and affect spouses' ability to provide care to the patient. ⋯ Longitudinal investigations are needed to understand burden and caregiving outcomes over time and the impact of burden on spousal and patient recovery outcomes.
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The advancements in surgical technique and perioperative care have significantly improved the survival of children with single ventricle (SV) congenital heart disease (CHD) over the past decade. The population who have undergone the Fontan operation are growing into adulthood and facing many unique challenges. Past research has focused on functional and neurodevelopmental outcomes with inferences made to health-related quality of life (HRQOL). ⋯ Questions still remain on how these patients will transition into adulthood and whether they will live normal productive lives. This article reviews the literature related to HRQOL in the SV subgroup of CHD. In addition, an overview of newly developed disease-specific HRQOL instruments is presented as well as limitations and future research in HRQOL of the SV Fontan population.
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The research was designed to describe the care and communication processes during weaning from long-term mechanical ventilation (LTMV). A portion of those findings, specifically, how family members interact with the patient and respond to the ventilator and associated intensive care unit bedside equipment during LTMV weaning, are reported here. ⋯ Critical care clinicians influence families' acquisition of interpretive surveillance skills at the bedside of patients who are being weaned from LTMV. This study provides a potentially useful conceptual framework of family behaviors with long-term critically ill patients that could enhance the dialogue about family-centered care and guide future research on family presence in the intensive care unit.
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The administration of dopamine using an in vivo animal model has been shown to prevent and treat diaphragm fatigue. ⋯ This study is the first to report the class and specific subtype of dopamine receptors found in the diaphragm. By identifying dopamine receptors in the diaphragm, we have a better understanding of the mechanisms by which dopamine treats and prevents diaphragm fatigue.
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Myocardial ischemia may be considered both a consequence of weaning from ventilation and a potential cause of weaning failure. A limited number of investigations have evaluated myocardial ischemia during mechanical ventilation and weaning and its effect on weaning success. The purpose of this pilot investigation was to determine the prevalence of myocardial ischemia in a diverse group of medical intensive care unit (MICU) patients during baseline mechanical ventilation, during weaning using continuous positive airway pressure, and up to 24 hours after extubation and to evaluate the relationship between ischemia and weaning failure. ⋯ Silent myocardial ischemia was a common occurrence in this diverse group of MICU patients, although only 21% had previously diagnosed coronary disease. Clinicians must be aware of the potential for silent ischemia, monitor and evaluate their patients for such, and intervene to promote optimal cardiovascular function, particularly during the stress of ventilator weaning.