AACN advanced critical care
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The syndrome of chronic critical illness has well-documented emotional, social, and financial burdens for individuals, caregivers, and the health care system. The purpose of this article is to provide experienced acute and critical care clinicians with essential information about the prevalence and profile of the chronically critically ill patient needed for comprehensive care. In addition, pathophysiology contributing to chronic critical illness is addressed, though the exact mechanism underlying the conversion of acute critical illness to chronic critical illness is unknown. Clinicians can use this information to identify at-risk intensive care unit patients and to institute proactive care to minimize burden and distress experienced by patients and their caregivers.
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The uncertain trajectory of chronic critical illness exposes the patient's family to heightened levels of psychological distress. Symptoms of psychological distress affect more than half of family members exposed to the patient's chronic critical illness. Although symptoms often dissipate over time, a significant proportion of family members will remain at moderate to high risk for psychological distress well after the patient's death or discharge from the intensive care unit. ⋯ Irrational or uninformed decision making can occur when family members experience high levels of psychological distress. Attention to the psychological needs and provision of support to family members enhance the formulation of treatment decisions consistent with the patient's preferences and mitigate unnecessary resource use. In this article, the impact of chronic critical illness on family members' risk for depression, anxiety, and posttraumatic stress disorder is described and a review of evidence-based strategies to support the psychological needs of family members coping with a patient's chronic critical illness is provided.
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Comparative Study
Simulation evaluation of an enhanced bedside monitor display for patients with sepsis.
Most standard bedside monitors in critical care settings display multiple clinical parameters and do not provide directional signaling to alert clinicians to relevant changes in physiologic parameters. The complexity of information may delay identification of clinical changes and initiation of interventions. Clinical decision support system (CDSS) tools can present information at appropriate intervals in formats that may enhance clinical decision making. ⋯ CDSS tools such as EBM may improve nurses' time to recognize and initiate treatment of sepsis.
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Comparative Study
Ultrasonography versus chest radiography after chest tube removal for the detection of pneumothorax.
Bedside ultrasound technology is an innovative, cost-effective, safe, and reproducible method used to make efficient decisions that directly affect the care of critical care patients. ⋯ Bedside ultrasound technology is as accurate as chest radiography in detecting pneumothorax following chest tube removal and can save institutions' time and money.
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Dismal survival statistics associated with sudden cardiac arrest have led to the development of new strategies and mechanical devices aimed at improving the quality of cardiopulmonary resuscitation (CPR). The most recent American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care were published in 2005. Major changes included revisions to current practices related to airway and ventilation, circulation, and defibrillation management. ⋯ This article focuses on current strategies aimed at improving survival rates for patients with sudden cardiac arrest. New techniques and mechanical devices developed to augment cardiopulmonary resuscitation will be discussed. These strategies will most likely shape future resuscitation practices.