Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 2006
ReviewArterial pressure-based technologies: a new trend in cardiac output monitoring.
New trends in cardiovascular monitoring use the arterial pulse as a less invasive means of assessing cardiac output. When adopting a new technology into practice, three questions need to be answered: (1) is the method technologically sound?, (2) is it based on physiologic principles?, and (3) are the applications clinically important? This article provides a clinical review on the technology, physiology, and applications of a new arterial pressure-based method of determining cardiac output and stroke volume variation as an additional parameter for fluid status assessment.
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Crit Care Nurs Clin North Am · Jun 2006
Review Case ReportsContinuous ST-segment monitoring: raising the bar.
ST-segment monitoring is recommended by clinical experts to assist in the early detection of transient myocardial ischemia; however, a gap exists between the recommendations and clinical practice. This article provides a review of research to support the use of ST-segment monitoring in a variety of clinical situations. Patient selection for monitoring, techniques, and strategies to facilitate successful implementation of ST monitoring are included. Nurses are encouraged to advocate for patients by raising the bar of electrocardiogram monitoring practice to aid in optimizing patient outcomes.
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Technologies now exist that measure carbon dioxide levels transcutaneously. Rapid assessment of patients who have depressed ventilation or suspected sepsis can improve treatment decisions including the need for admission to the ICU and pulmonary artery catheterization.
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In 2002, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) reviewed 23 reports of death or injury that were related to mechanical ventilation. Nineteen of those events resulted in death, and 4 resulted in coma; 65% were related to alarms. ⋯ This review prompted JCAHO to include alarm safety in the National Patient Safety Goals for 2003. This article examines the components of an alarm safety program, from the complex to the common sense.
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Crit Care Nurs Clin North Am · Jun 2006
Impact of bispectral index monitoring on sedation and outcomes in critically ill adults: a case series.
In situations in which clinical assessment of sedation level is compromised, such as deep sedation/analgesia with and without neuromuscular blockade (NMB), electroencephalogram-based monitoring may potentially assist in achieving balance between inadequate and excessive levels of sedation. To validate the bispectral index (BIS) for use in clinical practice, correlation and possible differences in outcome using clinical assessment versus clinical assessment augmented by electroencephalogram-based monitoring were determined. BIS monitoring was decisive in ICU care in 9 of 15 patients in this series. The most significant potential benefit was obtained in the subset of patients receiving NMB.