American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Clinical Trial
Effects of inhaled nitric oxide in patients with hypoxemia and pulmonary hypertension after cardiac surgery.
Cardiopulmonary bypass can increase pulmonary vascular tone and decrease ventilation-perfusion matching by impairing the pulmonary endothelial production of nitric oxide. ⋯ Inhalation of nitric oxide selectively decreases pulmonary vascular tone and increases ventilation-perfusion matching in patients with persistent pulmonary hypertension and hypoxemia after surgery requiring cardiopulmonary bypass. Inhalation of nitric oxide may be a valuable adjunctive therapy for these patients.
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Clinical Trial Controlled Clinical Trial
Preoperative ICU tours: are they helpful?
Although preoperative education decreases the anxiety of patients and family members, the usefulness of a preoperative tour of the ICU has not been studied. In this study, the effect of an ICU tour on the anxiety levels of patients (n = 92) and family members (n = 91) before and after cardiac surgery was examined. ⋯ ICU tours are included in many cardiac surgery educational programs. The majority of patients in this study perceived a benefit or a future benefit from an ICU tour, even though the tour did not significantly reduce the anxiety of the patients or family members.
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Although nurse educators and nurse managers have disagreed about which clinical competencies are necessary for new graduates to begin working in critical care, the competencies are in need of revision and reassessment. ⋯ The agreement between nurse educators and nurse managers supports a competency list for baccalaureate nursing curricula and hospital inservice programs to integrate new graduates into critical care.
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To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. ⋯ Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.
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Comparative Study
Comparison of heparinized and nonheparinized solutions for maintaining patency of arterial and pulmonary artery catheters.
Arterial and pulmonary artery catheters are often used in the management of critically ill patients. If heparin were not necessary to maintain the patency of arterial and pulmonary artery catheters, these patients could avoid exposure to heparin. ⋯ The failure rate of pulmonary artery catheters was not affected by the use of nonheparinized solutions. Arterial catheters failed less often when they were maintained with heparinized solutions. The authors recommend that all arterial catheters be maintained with heparinized solutions, unless use of heparin is contraindicated.