American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Observational Study
Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery.
Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. ⋯ Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.
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Randomized Controlled Trial
Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients.
Delirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs. ⋯ The patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.
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Multicenter Study
Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs.
Many medications commonly used in hospitals can cause prolonged corrected QT interval (QTc), putting patients at risk for torsade de pointes (TdP), a potentially fatal arrhythmia. However, documentation of QTc for hospitalized patients receiving QT-prolonging medications is often not consistent with American Heart Association standards. ⋯ A 3-step system-wide intervention was associated with an increase in QTc documentation for patients at risk for drug-induced TdP, and improvements persisted over time. Further study is needed to assess whether increased QTc documentation decreases occurrence of drug-induced TdP. (American Journal of Critical Care. 2015;24:e6-e15).
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Inhaled nitric oxide (iNO) is a rescue treatment for severe hypoxemia in the intensive care unit setting. ⋯ Use of iNO significantly improves oxygenation of patients with severe hypoxemia and allows safe transfer to a tertiary care center.