American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
To compare physicians' estimates of cardiac index and intravascular volume with transesophageal Doppler measurements obtained by critical care nurses, to assess the overall safety of transesophageal Doppler imaging by critical care nurses, and to compare hemodynamic measurements obtained via transesophageal Doppler imaging with those obtained via pulmonary artery catheterization. ⋯ Physicians' assessment of cardiac index and intravascular volume in patients receiving mechanical ventilation is correct less than half of the time. Transesophageal Doppler imaging by critical care nurses appears to be a safe method for measuring cardiac index and estimating intravascular volume. Measurements obtained via Doppler imaging correlate well with those obtained via pulmonary artery catheterization.
-
Assessment and management of patients' pain across practice settings have recently received the increased attention of providers, patients, patients' families, and regulatory agencies. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have aided in the improvement of pain management practices. ⋯ The state of nursing science of pain in critically ill patients, including development and testing of pain assessment methods and clinical trials of pharmacological interventions, is described. Special emphasis is placed on results from the Thunder Project II, a major multisite investigation of procedural pain.
-
Improving outcomes after serious injury is important to patients, patients' families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk. ⋯ Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.
-
Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. ⋯ Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.
-
Randomized Controlled Trial Clinical Trial
Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children.
Instillation of isotonic sodium chloride solution for endotracheal tube suctioning is controversial. Research has focused on the effect of such instillation in adults; no studies in children have been published. ⋯ Results of this study support a growing body of evidence that instillation of isotonic sodium chloride solution during endotracheal tube suctioning may not be beneficial and actually may be harmful.