American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Injectate port selection affects accuracy and reproducibility of cardiac output measurements with multiport thermodilution pulmonary artery catheters.
To compare the accuracy and reproducibility of thermodilution cardiac output measurements obtained from the injectate and infusion ports of a multilumen pulmonary artery catheter. The thermodilution results were compared with an independent measure of flow obtained from an electromagnetic flow meter. ⋯ The use of the infusion port for the measurement of thermodilution cardiac output measurements may result in nonreproducible and inaccurate results.
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The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. ⋯ The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.
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Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. ⋯ Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.
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Case Reports
Pressure-controlled inverse-ratio ventilation in children with acute respiratory failure.
We report the use of pressure-controlled inverse-ratio ventilation in two children with acute respiratory failure who were failing conventional mechanical ventilation. The children had subsequent improvement in oxygenation and ventilation without hemodynamic compromise. Pressure-controlled inverse-ratio ventilation was well tolerated by one patient who had increased intracranial pressure secondary to head injury. We were able to successfully hyperventilate, improve oxygenation and control intracranial pressure in this patient while using pressure-controlled inverse-ratio ventilation, which may prove to be an alternative method of ventilation for children with severe lung disease.
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In the last 10 years, the American Association of Critical-Care Nurses has twice ranked pain management as a priority issue for research and practice. Recent research findings suggest that undermedication of patients continues both in and out of critical care. Postoperative cardiac surgery patients have reported detailed recollections of pain experiences while in critical care, yet little is known about management of postoperative cardiac surgery pain. ⋯ The finding of small and infrequent analgesic doses is consistent with other studies conducted in and out of critical care. Important inconsistencies, or variations in practice, exist in both the prescription and administration of analgesics for postoperative cardiac surgery patients in the critical care setting.