Critical care nurse
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Critical care nurse · Dec 1998
Review Case ReportsUse of pulmonary rehabilitation strategies to wean a difficult-to-wean patient: case study.
The primary purpose of this article is to describe the effectiveness of an interdisciplinary team and innovative interventions by a pulmonary rehabilitation specialist in addressing one patient's failure to wean from mechanical ventilation. This case study shows the importance of considering both physical and psychological factors that may hinder weaning. ⋯ The patient's family participated in providing some of these interventions. With a concerted effort by all involved, the patient was successfully weaned from mechanical ventilation.
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Critical care nurse · Dec 1998
ReviewInhaled nitric oxide therapy for adult respiratory distress syndrome.
The selective pulmonary vasodilatory effects of inhaled nitric oxide decrease pulmonary artery hypertension and improve arterial oxygenation in patients with ARDS without causing concomitant systemic vasodilation. Inhaled nitrix oxide therapy may decrease the prevalence of pulmonary edema, pulmonary barotrauma, and oxygen toxicity that occur with current ARDS treatment. ⋯ Further research is needed to develop safe delivery systems and monitoring techniques for routine clinical use, to determine potential adverse and toxic effects of nitric oxide therapy on patients, and to determine the effects of long-term exposure to nitric oxide among healthcare workers. Concomitant administration of other medications with inhaled nitric oxide should also be investigated.
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Critical care nurse · Dec 1998
Case ReportsSuccessful use of extracorporeal membrane oxygenation to treat severe respiratory failure in a pediatric patient with a scald injury.
If ECMO is to be used effectively in pediatric patients, specifically in those with burns, the candidates must be chosen with care. Unlike the situation in neonates, when ECMO is being considered for use in a pediatric patient, no clear set of inclusion or exclusion criteria exists. Evaluation of a pediatric patient for ECMO support is largely based on an assessment of the patient's condition and a center's previous experience with pediatric ECMO. ⋯ The remaining prognostic signs--duration of ECMO support, frequency of complications, and blood product requirements--are available only after the ECMO course is under way or completed. The success of our center and others in using ECMO to treat respiratory failure associated with burns shows that some patients with burns may benefit from ECMO. Unfortunately, no specific set of criteria exists that would enable ECMO centers to differentiate good candidates from poor ones and thus be able to offer ECMO support with confidence in its benefit for the patient.