American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Intra-aortic balloon counterpulsation is the most widely used therapy for support of a compromised left ventricle. The principles of counterpulsation were developed in the 1950s, and intra-aortic balloon pumps have been used for more than 40 years. Despite this long-standing clinical use, many of the timing practices have continued almost unchanged from their inception. ⋯ The principles of timing are based on the physiological objectives of counterpulsation; however, research into alternative timing methods has led to conflicting and often confusing information on the appropriate timing method for a specific clinical situation or patient. Although a body of knowledge is available, much of the research is dated and covers only specific timing methods or populations of patients. Further evidence is needed to support the selection of timing methods and determine the clinical benefits of the various methods.
-
Many patients admitted to medical intensive care units require mechanical ventilation to assist with respiratory management. Unplanned extubations of these patients are associated with poor outcomes for patients and organizations. No previous research has investigated the role of standardized protocols in unplanned extubations when examined in conjunction with traditional risk factors. ⋯ Weaning protocols were associated with decreased incidence of unplanned extubation. Use of standardized protocols was feasible, as compliance among health care providers was high when protocols were medically prescribed. The reintubation rate in this study was low and associated with a significantly shorter ventilatory period and unit length of stay in the unplanned extubation group.
-
A 30° head-of-bed elevation is recommended for most critically ill patients. Measuring intrabladder pressure with the patient in this position is controversial. ⋯ It is feasible to measure intrabladder pressure with a 30° head-of-bed elevation, and that position could be an alternative to supine positioning of patients for measurement of intrabladder pressure.
-
The adverse effects of a failed ventilator weaning trial on the subsequent weaning attempts are not well understood. ⋯ Patients whose first ventilator weaning trial is unsuccessful may be markedly fearful. Left unaddressed, these fears cause high anxiety levels that significantly compromise respiratory function and contribute to subsequent weaning failures. Thus begins a vicious cycle of repeated failure of ventilator weaning and prolonged mechanical ventilation.
-
Clinical decision support systems are intended to improve patients' care and outcomes, particularly when such systems are present at the point of care. Protocol Watch was developed as a bedside clinical decision support system to improve clinicians' adherence to the Surviving Sepsis Campaign guidelines. This pre/post-intervention pilot study was done to evaluate the effect of Protocol Watch on compliance with 5 guidelines from the Surviving Sepsis Campaign. ⋯ Clinical decision support systems such as Protocol Watch may improve adherence to the Surviving Sepsis Campaign guidelines, which potentially may contribute to reduced morbidity and mortality for critically ill patients with sepsis.