AACN advanced critical care
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Acute and critical care nurses care for an increasingly aging population in the last stages of life. Unfortunately, many of these nurses do not have adequate education to care for this population. The End-of-Life Nursing Education Consortium (ELNEC) developed a critical care course, and in 2007 the Archstone Foundation provided a grant to educate critical care nurses in California. ⋯ After completing the national ELNEC-Critical Care train-the-trainer course, these participants taught more than 2900 classes in the ELNEC modules to their colleagues. Participants also revised policies and made system changes in their workplaces to provide better care to dying critical care patients and their families. The ELNEC/Archstone program improved acute and critical care nurses' end-of-life care education and, ultimately, practice and serves as a model for future educational efforts.
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Despite advances in treatment, acute respiratory distress syndrome (ARDS) remains a common cause of respiratory failure requiring ventilatory support and is associated with significantly high rates of morbidity and mortality. To date, the only treatment shown to increase survival rate in patients with ARDS is the use of supportive mechanical ventilation using low tidal volumes. ⋯ Recent literature shows varying mortality rates for the use of ECMO for ARDS; however, the literature suggests that transfer of patients to an ECMO center for treatment using specific criteria and indications may improve outcomes. Further research is needed regarding the timing of the initiation of ECMO, standardization of therapy, and which type of ECMO reduces morbidity and mortality rates in patients with ARDS.
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Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP). ⋯ No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.
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Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. ⋯ In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor's organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.