Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2012
Self/unplanned extubation: safety, surveillance, and monitoring of the mechanically ventilated patient.
The purpose of this article is to provide an appreciation for a significant risk to quality of care affecting patients receiving mechanical ventilation: unplanned extubation. A summary of the current literature provides evidence-based recommendations for how to minimize this potentially dangerous complication. In addition, recommendations for proceeding after unplanned extubation are made.
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Approaches to mechanical ventilation (MV) are consistently changing and the level of ventilator sophistication provides opportunities to improve pulmonary support for critically ill patients. Advanced MV modes are used in the treatment of patients with complex pulmonary conditions. ⋯ It's essential for nurses to integrate pulmonary MV knowledge in the care of critically ill patients. The purpose of this article is to describe the evidence supporting lung protective modes of MV used in the care of critically ill adults.
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It is estimated if each hospital implemented intensivist physician staffing, approximately 55,000 lives and $4.3 billion dollars could be saved in the United States. However, there is a limited supply of new critical care specialists as teaching hospitals have decreased the size of critical care programs for financial reasons. Tele-ICU can be used to provide coverage in facilities that cannot support a full-time specialist in critical care medicine and as an adjunct to facilities without 24-hour intensivist coverage. This article discusses the benefits and challenges of tele-ICU and its implications for nursing practice.
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Three transfusion complications are responsible for the majority of the morbidity and mortality in hospitalized patients. This article discusses the respiratory complications associated with these pathophysiologic processes, including definitions, diagnosis, mechanism, incidence, risk factors, clinical management, and strategies for prevention. It also explores how different patient populations and different blood components differentially affect the risk of these deadly transfusion complications. Lastly, the article discusses how health care providers can risk stratify individual patients or patient populations to determine whether a given transfusion is more likely to benefit or harm the patient based on the transfusion indication, risk, and expected result.
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Crit Care Nurs Clin North Am · Sep 2012
Weaning from mechanical ventilation: where were we then, and where are we now?
Weaning patients from long-term mechanical ventilation (LTMV) has been an important focus of clinical process improvement initiatives and research for decades. The purpose of this article is to describe the science that drives our current weaning practices, including (1) preweaning assessment, (2) individualized weaning plans, (3) weaning prediction, (4) the use of protocols and guidelines for weaning trials and sedation management, (5) timing of tracheostomy placement, and (6) system initiatives for the management of LTMV patients. Finally, this article discusses potential interventions for improving the outcomes of patients who require prolonged mechanical ventilation.