American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Increasing emphasis will be placed on the efficient delivery of healthcare. This article concentrates on recommendations for cost containment including increased cost consciousness, elimination of waste, improved quality of care, and use of the team approach to cost containment. The resources over which bedside nurses and managers in critical care have direct or indirect control are the focus of this discussion.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of continuous with intermittent bolus thermodilution cardiac output measurements.
Few complete studies have been published to validate the agreement between continuous cardiac output and intermittent thermodilution cardiac output. ⋯ The continuous cardiac output monitoring method shows clinically acceptable agreement with the intermittent cardiac output method.
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Nitric oxide is a significant biologic mediator in a number of physiologic processes. Clinical and laboratory studies in both human and animal models have uncovered a number of conditions responsive to nitric oxide therapy. The use of inhaled nitric oxide is rapidly expanding into neonatal and pediatric critical care. ⋯ Some patient populations that are refractory to conventional management demonstrate significant improvement when receiving nitric oxide therapy. This article discusses the physiologic properties of nitric oxide, as well as its diagnostic and therapeutic indications. Specific issues regarding nitric oxide delivery, monitoring, safety standards, and nursing care are also addressed.
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Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. ⋯ Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.
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In high-risk patients endovascular repair of a pseudoaneurysm with a stented graft is a safe and reasonable treatment option that can preclude significant morbidity and shorten hospital stay. We report a case of pseudoaneurysm of the subclavian artery after internal jugular vein cannulation that was treated successfully with an endovascularly inserted, stented graft. The case report highlights the importance of recognizing this unusual but serious complication of percutaneous internal jugular vein catheterization through careful clinical examination, prompt duplex scanning, and arteriography.