Aust Crit Care
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Randomized Controlled Trial Comparative Study
Comparison of an interactive CD-based and traditional instructor-led Basic Life Support skills training for nurses.
Basic Life Support (BLS) is a life-saving and fundamental skill in resuscitation. However, studies have reported limitations in BLS training outcomes for both health professional and lay populations, and noted the resource and time-intensive nature of traditional training approaches. ⋯ The failure to find a difference between the CD-based BLS programme with unsupervised manikin practice and a resource-intensive traditional instructor-led BLS training programme may indicate equivalence of the programmes or, even study design limitations. It is concerning that competence displayed by trainees from both groups was less than optimal and suggests the need for renewed efforts to develop and evaluate BLS training programmes which can achieve high rates of competence with acceptable skill retention over time.
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Randomized Controlled Trial
Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: a pseudo-randomised controlled trial.
Enteral nutrition (EN) for the critically ill and mechanically ventilated patients can be administered either via the continuous or bolus methods. However, there is insufficient evidence supporting which of these methods may have a lower risk of aspiration and gastrointestinal (GI) complications. This study was conducted in order to identify the incidence of aspiration and GI complications using continuous enteral nutrition (CEN) and bolus enteral nutrition (BEN) in critically ill patients at the Rafik Hariri University Hospital (RHUH), Beirut, Lebanon. ⋯ CEN versus BEN methods did not affect the incidence of aspiration, HGRV, vomiting or diarrhoea. However, the incidence of constipation was significantly greater in patients receiving CEN.
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Randomized Controlled Trial
Exploring the impact of augmenting sedation assessment with physiologic monitors.
Pharmacological sedation is a necessary tool in the management of critically ill, mechanically ventilated patients. The intensive care unit (ICU) sedation strategy is to use the least amount of medication to meet safety and comfort goals. Titration of pharmacological agents is currently guided by clinical assessment tools. The purpose of this study was to determine whether the addition of a neurophysiological monitor, bispectral index (BIS), aided the ICU nurse in reducing the amount of drug used, compared to a clinical tool alone, in a general critical care population. ⋯ The clinical evaluation of depth of sedation remains the most reliable method for the titration of pharmacological sedation in the critical care unit. However, BIS-augmented assessment is helpful in reducing the amount of propofol and narcotic medication used and may be considered an adjunct when these agents are utilised.
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Randomized Controlled Trial
Should gastric aspirate be discarded or retained when gastric residual volume is removed from gastric tubes?
Nursing care of patients with enteral feeding tubes is common in the intensive care unit but the evidence that surrounds the practice is limited. Recent research by Juve-Udina and colleagues (2010) "To return or to discard? Randomised trial on gastric residual volume management" compares two methods of managing gastric residual volume. This critique provides a brief summary of their research and critically appraises the paper. The implications for nursing practice are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Gastric residual volumes in critically ill paediatric patients: a comparison of feeding regimens.
This study examined the effect of gastric feeding regimens, either continuous or intermittent, on fourth hourly gastric residual volumes (GRV) in a group of critically ill paediatric patients where delayed gastric emptying is defined as a GRV greater than 5ml/kg. A randomised controlled trial was conducted in a tertiary paediatric intensive care unit (PICU), with 45 participants being randomly assigned to either the continuous (n=22) or intermittent (n=23) gastric feeding groups. Participants remained in the assigned group for the duration of the study and, fourth hourly, GRV were assessed to monitor the incidence of delayed gastric emptying. ⋯ The provision of enteral nutrition via the gastric route is a common treatment in the PICU, and GRV are frequently used as a measure of gastric tolerance. The result of this analysis provides some support for the theoretical definition of delayed gastric emptying being >5ml/kg. However, further work is required to confirm this finding and to determine its relevance when providing enteral nutrition to the critically ill paediatric patient.