Heart & lung : the journal of critical care
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Limited data are available on the efficacy of a common endotracheal suctioning intervention to prevent postsuctioning decreases in arterial oxygenation (PaO2). This study evaluated the effect on Pao2 of five hyperinflation (tidal volume 1.5 times normal) and hyperoxygenation breaths, administered before and after each of two consecutive endotracheal suctioning passes, with use of a manual resuscitation bag (PMR-2 model). The convenience sample consisted of 32 patients with endotracheal tubes who were observed within 24 hours of coronary artery bypass surgery. ⋯ In addition, a clinical measure of alveolar-capillary gas exchange (PaO2/PAO2 ratio) was found to be a significant predictor of PaO2 after suctioning, accounting for 38% of the variance. The data from this study support the efficacy of administering five hyperinflation and hyperoxygenation breaths, with use of a manual resuscitation bag, before and after endotracheal suctioning in stable patients after coronary artery bypass surgery. Further study is necessary to determine the efficacy of this suctioning intervention in patients with other respiratory problems.
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The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in the vital role that is therapeutic to them and their critically ill child. Many parent-supportive nursing interventions have been recommended but none has been tested in the clinical setting. ⋯ The experimental group participated in the NMPMC, designed to be supportive to and guided by the perceived individual needs of each parent. The dependent measure was the Parental Stressor Scale: Pediatric Intensive Care Unit administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicate that the NMPMC is helpful in alleviating parental stress, specifically the stress related to interruption in the parent-child relationship, in the PICU setting.
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The primary purpose of this study was to determine whether a modified Norton scale at admission to the hospital would predict which patients would develop pressure ulcers when hospitalized for surgery for a period of up to 3 weeks. The sample was composed of 387 adult patients admitted for elective cardiovascular surgery or neurosurgery. By regression analysis, no difference was found in the modified Norton scale scores for those who did and those who did not have pressure ulcers during hospitalization. ⋯ The knee and lateral malleolus were the sites of the most severe pressure ulcers. Subjects who were hospitalized for longer periods had more severe ulcers. Future research is needed to more precisely determine which patients in the acute care setting are at risk for the development of pressure ulcers.
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With positive end-expiratory pressure (PEEP)-induced reduction in cardiac output, measurement of ventricular filling pressure assists in proper therapeutic decision-making. Because PEEP may increase pleural and juxtacardiac pressure, central venous pressure (CVP) and left atrial pressure (LAP) measurements during PEEP may not simply reflect ventricular filling, but rather reflect the sum of intracardiac and extracardiac forces. Monitoring devices placed within the central circulation use saline solution-filled lumens and transducer systems for pressure monitoring. ⋯ In the present study, esophageal pressure (Pes) was measured with a saline solution-filled balloon-equipped nasogastric tube to estimate the extracardiac influence of PEEP on CVP and LAP. Pes, CVP, LAP, and cardiac index (CI) were measured in 17 patients subjected to 0, 5, 10, 15, 20 cm H2O PEEP. Comparing 0 with 20 cm H2O PEEP, CVP (7 +/- 1.0 mm Hg to 13.4 +/- 1.3 mm Hg), LAP (6.3 +/- 1.1 mm Hg to 11.7 +/- 1.4 mm Hg), and Pes (6.1 +/- 1.4 mm Hg to 12.1 +/- 1.5 mm Hg) all increased significantly as CI fell (2.72 +/- 0.14 L/min/m2 to 2.20 +/- 0.15 L/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)
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Closed system suctioning (CSS) is a method of removing secretions from the tracheobronchial tree of patients with mechanical ventilation without disconnecting the mechanical ventilator. The putative benefits of CSS include the maintenance of positive pressure ventilation, oxygen supply, and positive end-expiratory pressure (PEEP). However, some evidence indicates that negative airway pressure may develop during CSS if inappropriate ventilator settings are selected. ⋯ During each suctioning trial, the peak positive and negative airway pressures were recorded. The negative airway pressure was above -10 cm H2O in most situations. In the control mode at all flow rates with or without PEEP, the Bennett MA1 and the Bourns-Bear 1 and 2 produced sustained peak negative airway pressure of less than -50 cm H2O.(ABSTRACT TRUNCATED AT 250 WORDS)