AACN advanced critical care
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Much of the literature for end of life in the intensive care unit focuses on patients and their treatment. Families are usually present and should be a focus, as well as a resource, in end-of-life plans. Using categories from a recently published Society of Critical Care Medicine guideline on family support during an intensive care unit stay and 7 end-of-life domains, literature retrieved since 2000 was summarized. Topics addressed are decision making, spiritual and cultural support, emotional and practical support of families, including visitation and family preparation for death, and continuity of care.
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Ventilator-associated pneumonia is a costly complication of hospitalization that lengthens intensive care unit and hospital stay, increasing morbidity and mortality. Among evidence-based measures to prevent ventilator associated pneumonia is the use of a specialized endotracheal tube that aspirates subglottic secretions. ⋯ The purpose of this article is to review the available evidence regarding the use of an endotracheal tube with a subglottic secretion aspiration port to prevent ventilator-associated pneumonia. Issues, cost, benefits, and research recommendations will also be discussed.
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Multiple studies have been undertaken to show that neurofunction monitors can correlate to objective sedation assessments. Showing a correlation between these 2 patient assessments tools may not be the correct approach for validation of neurofunction monitors. ⋯ Neurofunction monitors provide near continuous information about a different domain of the sedation response than intermittent observational assessments. Further research should focus on contributions from this technology to the improvement of patient outcomes when neurofunction monitoring is used as a complement, not a replacement, for observational methods of sedation assessment.
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Eight published accounts about ventilator withdrawal spanning 1992-2004 were selected for review. Articles were selected if they contained data that described the processes comprising the withdrawal of mechanical ventilation as a terminal illness event. The purpose of this article is to synthesize the existing evidence about processes for the compassionate withdrawal of mechanical ventilation from intensive care unit patients, including measures of distress, premedication, medication during withdrawal, withdrawal methods, extubation considerations, duration of survival, and relationship of opioids or benzodiazepines to duration of survival. Practice recommendations will be suggested.
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Communicating well in the intensive care unit is essential to providing quality critical care for the families of patients who are expected to die. There are many examples in the literature of how clinicians fall short of meeting these needs of families. There is also a developing body of literature describing approaches and tools that may have a positive impact on the perceived quality of end-of-life communication. The quality of clinician communication can be improved just as other skills that are important in the intensive care unit.