American journal of critical care : an official publication, American Association of Critical-Care Nurses
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A computerized bibliographic search of published research and a citation review of English-language publications about prone positioning of patients with acute respiratory distress syndrome were done. Information on prone positioning related to technique, patients' responses, complications, and recommendations to prevent complications was extracted. In the 20 pertinent clinical studies found, 297 patients (mean age, 39 years) with acute respiratory failure were positioned prone. ⋯ The most serious complication, corneal abrasion requiring corneal transplantation, was reported in one patient. Clinical knowledge about prone positioning is limited. Phase 1 studies focusing on how to safely turn and care for critically ill patients positioned prone for prolonged periods are needed.
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Review Randomized Controlled Trial Comparative Study Clinical Trial
Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction.
To determine the effect of 5-mL injectate on cardiac output measurements in critically ill patients with low ventricular ejection fraction (< 35%). ⋯ Cardiac outputs measured with 5- and 10-mL injectates do not differ significantly. The greater variability of measurements obtained with a 5-mL injectate suggests that more measurements, and thus more time, are needed to measure cardiac output accurately. Clinicians must weigh the benefit of minimizing fluid volume used against the potential decreased reliability of cardiac output measurements.
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Fever is a common phenomenon in critically ill patients. Ideally, all decisions about treatment of fever would be based on results of well-developed research studies. ⋯ This article is an evaluation of the usefulness of the research studies related to treatment of fever in the critically ill. Two questions are addressed: when is treatment of fever most beneficial to a critically ill patient, and how is fever most effectively treated in the critically ill? Evidence related to the treatment of fever is evaluated by using the recommendation levels of the research-based practice protocols of the American Association of Critical-Care Nurses.
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The American Heart Association is championing a national effort to make automated external defibrillators available to the public. Clinicians are beginning to grapple with the complexities involved in training laypersons to use these devices. The article reviews the experience of researchers involved in such training. ⋯ So far, widespread training of traditional first responders such as police and firefighters to use automated external defibrillators appears to be safe and effective. The data from studies in which nontraditional responders were trained are not as convincing. Further research is needed before we can assume that training of the public will be as easy and effective as training of traditional first responders.