American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Nurses are often responsible for placement of large-bore gastric tubes. Tube misplacement into the lungs is a potential complication with serious sequelae. The reliability of common bedside methods for differentiating between pulmonary and gastric placement has not been acceptable. ⋯ Neither air insufflation nor capnometry is a fail-safe method for determining placement of gastric tubes. Radiography remains the preferred method.
-
Multicenter Study
An efficiency evaluation of protocols for tight glycemic control in intensive care units.
The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. ⋯ Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.
-
Cessation of circulation during cardiac arrest causes critical end-organ ischemia. Although the neurological consequences of cardiopulmonary arrest can be catastrophic, an aggressive "push fast and push hard" resuscitation technique maintains blood flow until the return of spontaneous circulation. However, reperfusion to the cerebrum leads to cellular chaos and further neurological injury. ⋯ A 43-year-old man had 2 asystolic arrests with 20 minutes of cardiopulmonary resuscitation as a result of massive, multiple pulmonary emboli. After the cardiac arrest, the patient was comatose and posturing. The 2005 American Heart Association guidelines for cardiopulmonary resuscitation were used along with moderate hypothermia in an attempt to minimize the neurological consequences of the cardiopulmonary arrest and to optimize the patient's outcome.
-
Randomized Controlled Trial
Animal-assisted therapy in patients hospitalized with heart failure.
Animal-assisted therapy improves physiological and psychosocial variables in healthy and hypertensive patients. ⋯ Animal-assisted therapy improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.
-
Blood glucose control during acute illness has been associated with improved outcomes. ⋯ Protocol adherence was positively associated with daily time in the target range, but efficacy during the total protocol implementation time remained poor. Because of the frequency of hypoglycemia, protocols to maintain blood glucose levels between 81 and 110 mg/dL in critically ill patients may not be recommended.