Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Sep 2013
ReviewAirway pressure release ventilation: improving oxygenation: indications, rationale, and adverse events associated with airway pressure release ventilation in patients with acute respiratory distress syndrome for advance practice nurses.
Airway pressure release ventilation (APRV) is a mode of ventilation that has been around since the 1980s and was originally viewed as a type of continuous positive pressure mode of ventilation. Conceptually, APRV can be thought of as a type of inverse-ratio, pressure-controlled, intermittent mandatory ventilation during which the maintenance of spontaneous breathing and prolonged application of high mean airway pressure contribute to the clinical benefits. The aim of this review article was to familiarize the bedside clinician working in the intensive care unit with the theory and rationale behind this mode of ventilation. The potential advantages and disadvantages of APRV will also be discussed to empower the advance practice clinician and bedside nurse to advocate for their patient diagnosed with the often-high mortality disease of acute respiratory distress syndrome.
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Dimens Crit Care Nurs · Sep 2013
A pilot study on delirium in the intensive care unit: a creative inquiry project with undergraduate nursing students.
Delirium continues to be a major issue in intensive care units (ICUs). Sedation and lack of rapid eye movement (REM) sleep could be important factors in the development of delirium. Improper sedation may interfere with a patient's sleep pattern, specifically time spent in REM sleep, and could be a contributor to the development of delirium. The research team has discovered through this pilot study that there is a possible correlation between sedation, disruptions, and sleep. The goal of our research was to determine the relationship between these variables using a sleep monitor to capture actual sleep activity compared with patient characteristics and real-time activity in the ICU environment. ⋯ Preliminary results show that there is a relationship between lack of REM sleep and delirium. The pilot study was a useful model to demonstrate the need for further investigation in a larger population.
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Dimens Crit Care Nurs · Sep 2013
Inhaled epoprostenol to support the severely hypoxemic patient with acute respiratory distress syndrome.
This article presents a case study demonstrating various rescue therapies considered in the care of a patient with severe, refractory hypoxemia secondary to acute respiratory distress syndrome. In particular, inhaled epoprostenol (Flolan) is becoming an increasingly common alternative to nitric oxide in the treatment of severe, refractory hypoxemia. Research comparing the 2 inhaled vasodilators suggests that epoprostenol is equally efficacious, easier to administer, less costly, and has fewer adverse effects. This article, using a case study approach, discusses the practical implications of this emerging therapy.