American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The needs and satisfaction levels of family members of critically ill patients have received much attention in the literature. The feelings of family members, however, have not been thoroughly investigated. To develop appropriate nursing interventions to assist family members in coping with a critical care hospitalization, accurate information about their emotional response to the situation is needed. ⋯ The findings suggest that family members of critically ill patients experience deep emotional turmoil throughout the intensive care unit stay. Specific nursing interventions to promote adaptive coping are needed throughout the experience.
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Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. ⋯ Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.
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Case Reports
Pressure-controlled inverse-ratio ventilation in children with acute respiratory failure.
We report the use of pressure-controlled inverse-ratio ventilation in two children with acute respiratory failure who were failing conventional mechanical ventilation. The children had subsequent improvement in oxygenation and ventilation without hemodynamic compromise. Pressure-controlled inverse-ratio ventilation was well tolerated by one patient who had increased intracranial pressure secondary to head injury. We were able to successfully hyperventilate, improve oxygenation and control intracranial pressure in this patient while using pressure-controlled inverse-ratio ventilation, which may prove to be an alternative method of ventilation for children with severe lung disease.
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In the last 10 years, the American Association of Critical-Care Nurses has twice ranked pain management as a priority issue for research and practice. Recent research findings suggest that undermedication of patients continues both in and out of critical care. Postoperative cardiac surgery patients have reported detailed recollections of pain experiences while in critical care, yet little is known about management of postoperative cardiac surgery pain. ⋯ The finding of small and infrequent analgesic doses is consistent with other studies conducted in and out of critical care. Important inconsistencies, or variations in practice, exist in both the prescription and administration of analgesics for postoperative cardiac surgery patients in the critical care setting.
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Review Comparative Study
Drawing coagulation studies from arterial lines: an integrative literature review.
How much blood must be discarded from a heparinized arterial line to obtain accurate coagulation studies, specifically activated partial thromboplastin time? The published literature provides insight into the question and guidelines for practice in adult critical care. This article reviews and integrates findings from 14 research studies published from 1971 to 1993 on discarding blood from arterial lines for coagulation studies. ⋯ Studies have demonstrated that adequate discard volume for activated partial thromboplastin time is 6 times the catheter dead space. These results should not be generalized to systemically heparinized patients, pediatric patients, or other types of heparinized lines such as pulmonary artery, central venous, or Hickman catheters.