American journal of critical care : an official publication, American Association of Critical-Care Nurses
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After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. ⋯ Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.
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High-quality communication is a key determinant and facilitator of patient-centered care. Nurses engage in most of the communication with patients and patients' families in the intensive care unit. ⋯ Critical care, including communication, is a collaborative effort. Understanding how nurses engage in patient-centered communication in the intensive care unit can guide future interventions to improve patient-centered care.
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Problems persist with surrogate decision making in intensive care units, leading to distress for surrogates and treatment that may not reflect patients' values. ⋯ The Four Supports Intervention is feasible, acceptable, and was perceived by physicians and surrogates to improve the quality of decision making and the patient-centeredness of care. A randomized trial is warranted to determine whether the intervention improves patient, family, and health system outcomes.
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Timely diagnosis and prognostic assessment of ventilator-associated pneumonia remain major challenges in critical care. ⋯ In patients with ventilator-associated pneumonia, serum levels of the receptor plus the pulmonary infection score are useful for diagnosis, and procalcitonin levels plus the pulmonary infection score are useful for prognostic assessment.