American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The purpose of this study was to describe ways in which withdrawal of mechanical ventilation is carried out in one institution, patient responses to the various methods of withdrawal, and nurses' perceptions of the methods and morality of ventilator withdrawal. ⋯ These results provide a foundation for preliminary recommendations about the most humane form of ventilator withdrawal and the appropriate use of narcotics and sedatives during withdrawal.
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Clinical Trial Controlled Clinical Trial
Effect of backrest position on hemodynamic and right ventricular measurements in critically ill adults.
Hemodynamic measurements are often obtained with the patient in a flat, supine position. Reports suggest that these measurements can be reliably obtained at backrest elevations from 0 degree to 45 degrees. However, no study has been performed to evaluate the effects of position change on all the measurements that can be obtained via a pulmonary artery catheter. ⋯ Findings support the hypothesis that a patient need not be placed flat to obtain accurate hemodynamic and volumetric measurements. Results of this study are consistent with those of previous research and extend previous results to include the volumetric measurements of end-diastolic volume index and right ejection fraction. In addition, the use of mechanical ventilation and vasoactive drugs did not alter the accuracy of the measurements at backrest elevations from 0 degree to 45 degrees.
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This study examined the validity of medical-record-based nursing assessment and monitoring of signs and symptoms (nursing surveillance) in predicting patients who were admitted to ICUs and those admitted to non-ICUs. The association of this assessment and monitoring with differences in an intermediate patient outcome, instability at discharge, was also explored. Patients admitted to either setting with a diagnosis of acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia, were included in the study. ⋯ ICU patients (n = 3969) were found to have a longer length of stay and to be sicker on admission than non-ICU patients (n = 7277). Overall, patients in the ICU received significantly higher nursing assessment and monitoring of signs and symptoms scores than non-ICU patients. Nursing assessment and monitoring of signs and symptoms scores were lower for patients discharged with greater instability for three of the four diseases (cerebrovascular accidents, congestive heart failure, and pneumonia).