American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Comparison of the lower inflection point on the static total respiratory compliance curve with outcomes in postoperative cardiothoracic patients.
Routine use of positive end-expiratory pressure (based on the pressure at the lower inflection point on the static total respiratory compliance curve) along with a maneuver to recruit atelectatic lung has been advocated after cardiothoracic surgery. ⋯ In patients with short intubation times and predictable postoperative course, general use of a lung recruitment strategy involving sustained inflations and adjustment of positive end-expiratory pressure based on the lower inflection point is difficult to justify.
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Multiple rib fractures in trauma patients are associated with significant morbidity and mortality. Delayed morbidity for patients with rib fractures is often a result of hypoventilation leading to atelectasis, pneumonia, and respiratory failure. Pain management was first recognized as an important factor in preventing complications in these patients. ⋯ It is now known that patients with multiple rib fractures benefit most from adequate pain control, rapid mobilization, and meticulous respiratory care to prevent complications. A protocol based on a synthesis of the existing literature is developed. Development of such a protocol for decisions about rapid mobilization, respiratory support, and pain management is the first step in testing the hypothesis that these interventions will decrease the length of patients' stay in intensive care units.
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Comparative Study
Comparison of outcome predictions made by physicians, by nurses, and by using the Mortality Prediction Model.
Critical care nurses must collaborate with physicians, patients, and patients' families when making decisions about aggressiveness of care. However, few studies address nurses' ability to predict outcomes. ⋯ Nurses can predict survival outcomes as accurately as physicians do. Greater sensitivity and specificity are necessary before clinical judgment or predictive tools can be considered as screens for determining aggressiveness of care.