American journal of critical care : an official publication, American Association of Critical-Care Nurses
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To help the clinician bridge the gap between research and practice in determining ways to minimize side effects of endotracheal suctioning. ⋯ An algorithm to guide clinical decision making is presented based on the conclusions of this review of the research.
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Clinical Trial
Effects of a closed tracheal suction system on ventilatory and cardiovascular parameters.
To determine whether patients ventilated in the assist-control mode experienced a change in oxygenation, respiratory rate, inspiratory:expiratory ratio, heart rate, blood pressure or acid-base balance when suctioned with a closed tracheal suction system. ⋯ Subjects ventilated in the assist-control mode and suctioned with a closed tracheal suction system did not experience significant changes in cardiovascular or acid-base parameters when suctioned without hyperoxygenation. Although most subjects did not become desaturated, four subjects experienced desaturation at one or more intervals. To prevent desaturation, hyperoxygenation should be used before and after suctioning with a closed tracheal suction system.
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To describe the characteristics and service utilization patterns of long-term ventilator-dependent patients. ⋯ Additional studies are necessary to describe the prevalence, etiology, health status and functional status of ventilator patients at all levels of care; the impact of different system approaches on patient well-being and cost of care; and the process of medical decision making. Economic analyses of costs and outcomes for ventilator-dependent patients using a cost-utility approach are also needed.
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Decisions to withdraw life-sustaining therapy are being made more often as patients and healthcare providers increase their awareness of patient rights. The process of withdrawal of mechanical ventilation must be conducted in a humane fashion. An understanding of the ethical, legal and practical considerations for patient management during this type of intervention will enhance the ability of the healthcare provider to participate.