American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Review Meta Analysis
Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis.
Immobility is associated with complications involving many body systems. ⋯ Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.
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To review the literature on the limitations and consequences of packed red blood cell transfusions, with particular attention to critically ill patients. ⋯ According to the available data, transfusion of packed red blood cells should be reserved only for situations in which clear physiological indicators for transfusion are present.
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Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture. ⋯ Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses' perceptions of use, actual practice, and currently established local policies.
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Long stays in the intensive care unit are associated with high costs and burdens on patients and patients' families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit. ⋯ Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients' families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.
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Review Meta Analysis
Mechanical thromboprophylaxis in critically ill patients: a systematic review and meta-analysis.
To systematically review the randomized trials, observational studies, and survey evidence on compression and pneumatic devices for thromboprophylaxis in intensive care patients. ⋯ The limited evidence suggests that use of compressive and pneumatic devices yields results not significantly different from results obtained with no treatment or use of low-molecular-weight heparin. Until large randomized controlled trials are conducted, the role of mechanical approaches to thromboprophylaxis for intensive care patients remains uncertain.