American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
As many as half of critically ill patients require mechanical ventilation. In this article, a program of research focused on reduction of risk associated with mechanical ventilation is reviewed. Airway management practices can have profound effects on outcomes in these patients. ⋯ The overall goals of sedation are to provide physiological stability, to maintain ventilator synchrony, and to ensure patients' comfort-although methods to evaluate achievement of these goals are limited. Reducing risks associated with mechanical ventilation in critically ill patients is a complex and interdisciplinary process. Our understanding of the risks associated with mechanical ventilation is constantly changing, but care of these patients must be based on the best evidence.
-
Identifying predictors of length of stay in the intensive care unit can help critical care clinicians prioritize care in patients with acute, life-threatening injuries. ⋯ Systemic inflammatory response syndrome scores can be measured quickly and easily at the bedside. Data support use of the score to predict length of stay in the intensive care unit.
-
Patients with heart failure often experience depressive symptoms that affect health-related quality of life, morbidity, and mortality. Researchers have not described the experience of patients with heart failure living with depressive symptoms. Understanding this experience will help in developing interventions to decrease depressive symptoms. ⋯ Patients with heart failure experience symptoms of depression that are similar to those experienced by the general population. Clinicians should assess patients with heart failure for stressors that worsen depressive symptoms. Strategies that researchers and clinicians can use to reduce depressive symptoms in patients with heart failure include engaging patients in activities, positive thinking, and spirituality. Helping patients find enhanced social support may also be important.
-
Although oral health affects systemic health, studies of oral health during intubation among critically ill neuroscience patients are lacking. Furthermore, the effect of oral care on intracranial pressure among critically ill patients in a neuroscience intensive care unit is unknown. ⋯ Intubation may contribute to worsening of oral health among patients in neuroscience intensive care units. Execution of oral care does not seem to affect intracranial pressure adversely. Oral care should be explored further to promote good oral and systemic health in patients in neuroscience intensive care units and to determine its effect on ventilator-associated pneumonia.
-
Case Reports
Acute ST-segment elevation myocardial infarction associated with diclofenac-induced anaphylaxis: case report.
A patient in whom acute myocardial infarction developed during diclofenac-induced anaphylaxis is described. ST-segment elevation myocardial infarction is a rare complication of anaphylactic reactions, but can occur even in patients with angiographically normal coronary arteries. ⋯ To our knowledge, this is the first reported case of Kounis syndrome due to diclofenac. The patient's recovery was uneventful.