Heart & lung : the journal of critical care
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The purpose of this study is to identify independent preoperative, intraoperative, and postoperative determinants of intensive care unit (ICU) length of stay in patients undergoing coronary artery bypass graft (CABG) surgery and to evaluate the usefulness of a mortality risk scoring system, the Parsonnet score, as a prognostic indicator of ICU length of stay after CABG. ⋯ Preoperative and postoperative variables explained a large portion of the variance in ICU stay after CABG. Although the Parsonnet score was not helpful in identifying patients who require only a short ICU stay, it may help clinicians screen for patients likely to require stays >1 day and plan appropriate use of resources in the ICU.
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The primary purpose of this study was to assess the relationship between preoperative risk factors, postoperative chronic pain, sleep, and gender on perceptions of quality of life (QoL) in a sample of 123 coronary artery bypass graft (CABG) surgery patients 12 months after surgery. A secondary purpose was to determine whether there is concordance between spousal and patient reporting of QoL after CABG surgery. ⋯ CABG surgery results in improved QoL for the majority of patients with extensive coronary artery disease. Nevertheless, some patients continue to have severe pain, sleep disturbances, and altered relationship with their spouse or NoK 12 months after surgery.
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The purposes of this study were to investigate the hemodynamic changes induced by intermittent manual lung hyperinflation (MHI) and to assess if these changes are adverse enough to warrant prohibition of MHI as a routine procedure in the care of patients with septic shock. ⋯ The hemodynamic effects of intermittent MHI in patients with septic shock are relatively small and insignificant and seem to be related to the cardiovascular state before the procedure. The risk of inducing hemodynamic changes with MHI should not be considered as a contraindication in patients with septic shock who are mechanically ventilated.
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The purpose of this study was to determine the degree of agreement between clinically observed muscle movement(s) and train-of-four scores obtained by peripheral nerve stimulation during a neuromuscular blocking agent infusion and after it was discontinued. ⋯ Until additional research is available, nurses must titrate the neuromuscular blocking agent infusion on the basis of the clinical endpoints for paralysis in combination with an assessment of the child's movements and response to peripheral nerve stimulation to prevent overdose and prolonged muscle paralysis.
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No published studies focus on determining the frequency of dysrhythmias during pulmonary artery catheter removal by use of a standard technique. The objective was to assess the incidence and hemodynamic effect of dysrhythmias in patients who had recently undergone cardiac surgery (within 24 hours of when dysrhythmia was noted). ⋯ The use of a standard technique for pulmonary artery catheter removal demonstrated a 2% incidence of nonsustained ventricular tachycardia associated with transient hypotension. Fewer incidences of dysrhythmias were noted in the patients (4 of 29) who had abnormal serum potassium levels, abnormal pH, or pharmacologic association during catheter removal in comparison with those patients without this association (15 patients of 71). No statistically significant difference was noted in the incidence of dysrhythmia during pulmonary artery catheter removal between these 2 groups (chi(2) = 0.72, P =.39).