Heart & lung : the journal of critical care
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The purpose of this study was to explore the extent and sources of variability of critical care nurses' hemodynamic decision making as a function of contextual factors in the immediate 2-hour period after cardiac surgery. ⋯ This observed variability can occur in multiple ways and in hemodynamic decision making has implications for patient outcomes as behaviors of non-integrated TDM led to nurses sensing a loss of control of patient management.
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Comparative Study Clinical Trial
Transient myocardial ischemia is an independent predictor of adverse in-hospital outcomes in patients with acute coronary syndromes treated in the telemetry unit.
The purpose of this study was to determine whether transient myocardial ischemia (TMI) is predictive of adverse in-hospital outcomes among patients admitted to a telemetry unit with acute coronary syndrome (ACS). ⋯ TMI is an independent predictor of in-hospital complications among patients with ACS treated in the telemetry unit setting. Continuous 12-lead ECG ST-segment monitoring provides prognostic information for risk stratification of patients admitted to the hospital for treatment of ACS.
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Multicenter Study
Pain intensity and postoperative pulmonary complications among the elderly after abdominal surgery.
The purpose of this study was to determine whether postoperative pain intensity differs between elderly abdominal surgery patients in whom postoperative pulmonary complications (PPC) develop and those in whom they do not. ⋯ Results provide support for viewing pain as a factor that contributes to the development of PPCs among the elderly population after abdominal surgery. Therefore, nursing interventions of pain assessment and management, deep breathing, and ambulation may influence the incidence of this outcome.
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Comparative Study
Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease.
The purpose of this study was to make comparisons between different types of exercise tests used in chronic obstructive pulmonary disease (COPD) to better interpret the results and to select the most suitable testing procedure. Therefore, we evaluated the relationship between exercise capacity and other clinical measures and their relative contributions to exercise capacity in patients with COPD. ⋯ The 3 different exercise tests had similar characteristics in relation to pulmonary function, dyspnea, and health-related quality of life in patients with COPD. However, some differences were found in the aspects they evaluated.
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To determine baseline values of cardiac index (CI) and oxygen transport variables in patients with multiple trauma within 24 hours of admission to a level I trauma center. ⋯ All patients were hypermetabolic, but older patients were much less so. Younger patients progressively had increased CI and DO2 levels, whereas older patients started with low levels that remained so. Patients in each age group appeared to lock into a level of VO2 that did not change over time. These findings underscore the vulnerability of older patients to poor outcomes. As the magnitude of the postinjury response is partly age-dependent, future research should differentiate patient characteristics associated with positive outcomes among elderly trauma patients.