American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Despite the frequency of intrahospital transport of critically ill patients, little research has been done on this topic and the findings are contradictory. ⋯ Transport outside the intensive care unit places the critically ill patient at additional risk. Although transport is often unavoidable, its risks versus benefits should be carefully and collaboratively evaluated for every patient prior to making the decision for transport.
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Hyperventilation is a frequently used method for inducing hypercarbia in neurosurgical patients. This practice requires careful carbon dioxide monitoring that might be replaced by a less expensive and less invasive alternative to arterial blood gas monitoring. ⋯ In this patient sample, changes in end-tidal carbon dioxide values did not accurately reflect changes in arterial carbon dioxide tension levels in the intensive care setting. Further technological advances in noninvasive carbon dioxide monitoring may lead to a significant cost savings over traditional arterial blood gas analysis.
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Few studies have documented stressors experienced by patients recovering from cardiac surgery in the intensive care unit. Furthermore, research has indicated that nurses' predictions of stressors often are not accurate. Stressors frequently experienced by cardiac surgical patients in the intensive care unit must be clearly identified to enable nurses to predict them, plan interventions to minimize them, and help patients cope. ⋯ Our results suggest that interventions reducing stressors enhance the recovery process for cardiac surgical patients.
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Although many investigators have attempted to identify weaning predictors and weaning modes for use in long-term mechanically ventilated patients, none has emerged as superior. Furthermore, few investigators have viewed the process of weaning as a dynamic continuum; thus, guidelines for care of these patients have yet to be developed. ⋯ Care delivery systems, which focus on systematic, comprehensive and coordinated care, are promising because outcomes demonstrate that they are economical, safe, and effective. This article reviews the research on weaning adult, long-term mechanically ventilated patients, suggests future research directions, and highlights the scientific basis for practice guidelines.