American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Norepinephrine Dosing in Obese and Nonobese Patients With Septic Shock.
Whether or not norepinephrine infusions for support of hemodynamic status in patients with septic shock should be weight based is unknown. This situation is particularly pertinent in patients who are extremely overweight or obese. ⋯ The final cohort consisted of 100 obese and 100 nonobese patients. Mean norepinephrine infusion rate at 60 minutes was 0.09 (SD, 0.08) μg/kg per minute in the obese group and 0.13 (SD, 0.14) μg/kg per minute in the nonobese group (P = .006). The non-weight-based dose at 60 minutes was 9 μg/min in obese patients and 8 μg/min in nonobese patients (P = .72). The log transformed mean arterial pressure to norepinephrine ratio at 60 minutes was 2.5 (SD, 0.9) in obese patients and 2.5 (SD, 0.8) in nonobese patients (P = .54) CONCLUSIONS: Compared with nonobese patients, obese patients with septic shock require lower weight-based doses of norepinephrine and similar total norepinephrine doses.
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Critical illness comprises a heterogeneous group of serious medical conditions that typically involve an initial proinflammatory process. A compensatory anti-inflammatory response may occur that, if severe and persistent, places the patient at high risk for adverse outcomes including secondary infection and death. ⋯ Intriguing data suggest that critical illness-induced immune suppression may be reversible with agents such as interferon-γ, granulocyte macrophage colony-stimulating factor, interleukin 7, or anti-programmed death-1 therapy. Future approaches for characterization of patient-specific immune derangements and individualized treatment could revolutionize how we recognize and prevent complications in critically ill patients.
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Variability in disposition of children according to the time of rapid response calls is unknown. ⋯ Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.
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Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. ⋯ The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments.
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Satisfaction With Elimination of all Visitation Restrictions in a Mixed-Profile Intensive Care Unit.
Open and patient-tailored guidelines have been recommended as the preferred visitation model in critical care settings; however, many critical care units continue to restrict visitation. ⋯ Elimination of even minimal restrictions on visitation hours improved family satisfaction and improved nurses' perceptions of family satisfaction with the visitation policy. Nurses' satisfaction did not change. These findings support open and patient-centered visitation guidelines in critical care settings.