AACN advanced critical care
-
Despite progress in the management of adults with severe traumatic brain injury, several controversies persist. Among the unresolved issues of greatest concern to neurocritical care clinicians and scientists are the following: (1) the best use of technological advances and the data obtained from multimodality monitoring; (2) the use of mannitol and hypertonic saline in the management of increased intracranial pressure; (3) the use of decompressive craniectomy and barbiturate coma in refractory increased intracranial pressure; (4) therapeutic hypothermia as a neuroprotectant; (5) anemia and the role of blood transfusion; and (6) venous thromboembolism prophylaxis in severe traumatic brain injury. Each of these strategies for managing severe traumatic brain injury, including the postulated mechanism(s) of action and beneficial effects of each intervention, adverse effects, the state of the science, and critical care nursing implications, is discussed.
-
Evidence is needed to validate rapid response teams (RRTs), including those led by nurse practitioners (NPs). A descriptive-comparative mixed-methods study was undertaken to evaluate a newly implemented NP-led RRT at 2 Canadian hospitals. ⋯ A paper survey revealed that ward nurses had confidence in the knowledge and skills of the NP-led RRT and believed that patient outcomes were improved as a result of their RRT call. These findings indicate that NP-led RRTs are a safe and effective alternative to intensivist-led teams, but more research is needed to demonstrate that RRTs improve hospital care quality and patient outcomes.
-
Current guidelines support therapeutic hypothermia after cardiac arrest. An esophageal temperature probe (ETP) provides a core temperature assessment; however, accurate placement is necessary. ⋯ Literature is lacking to guide ETP placement. In this study, RNs overestimated the depth for ETP insertion. Accurate temperature readings are highly dependent on accurate anatomical location placement. Providing skill competency training that incorporated anatomical imaging technology enhanced RNs' awareness for effective skill acquisition.
-
Left ventricular assist devices (LVADs) have become accepted as treatment for heart failure as a result of improvements in diagnosing and treating left ventricular failure and limited donor availability. In the Pivotal Study of the HeartMate II in the bridge to transplantation population, the incidence of right ventricular failure without the implantation of a right ventricular assist device was 14%, with an additional 6% of the participants ill enough that they required implantation of a right ventricular assist device. This complication increases mortality, cost, and length of stay. This article reviews the screening of LVAD candidates for the probability of right ventricular failure postoperatively, the evaluation of right ventricular function in LVAD candidates, and the optimal management of the right ventricle during the perioperative care of LVAD patients.
-
Morbidity and mortality in patients with cardiogenic shock remain high despite the recent advances in therapy. New temporary ventricular assist devices (VADs) that are rapidly applied to normalize cardiac output in patients with severe heart failure are being used more frequently. Bridge to decision describes the temporary use of a VAD to stabilize critically ill patients until complete diagnostic tests are performed and decisions about more definitive therapy are made. ⋯ Anticoagulation therapy is commonly required, and bleeding is a frequent complication. Infection prevention measures must be used to avoid septic complications. In the past 10 years, clinical experience with these devices has expanded, but they remain underused.