Heart & lung : the journal of critical care
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To identify and describe a range of functional health outcomes in a sample of sudden cardiac death survivors. ⋯ Despite significant decreases in physical functioning and reports of mild to moderately severe cognitive impairments, only a minority of sudden cardiac death survivors are severely psychologically distressed. Illness severity is a strong predictor of physical functioning, but its contribution to psychologic distress is indirect, acting largely through the aegis of poor physical functioning and loss of prearrest work status.
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Clinical judgment in critical care is supported by a rich social network of care providers. The purpose of this study was to describe the social context in which the process of critical care clinical judgment occurs from the nurse's perspective. ⋯ Nurses and physicians were organized in hierarchies of nurse manager, resource nurse, charge nurse, and staff nurse or attending surgeon, fellow, chief resident, and resident. These parallel hierarchies allowed for checks on judgment both within and across professional lines. Rituals, such as nursing report, physician rounds, and flow sheet use, provided a context for a critique on judgment processes. Communication of judgment was frequently a casual, open conversation. At other times, differences in perspective could result in conflict. Communication between nurses and physicians has been associated with better patient outcomes. Critical care unit directors and managers can use an analysis of communication patterns to develop supports to clinical judgment.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the effects of assist-control, SIMV, and SIMV with pressure support on ventilation, oxygen consumption, and ventilatory equivalent.
To quantify the ventilatory efficiency of different modes of mechanical ventilation used to achieve full ventilatory support in normal subjects. Modes compared were assist-control, synchronized intermittent mandatory ventilation (SIMV), and SIMV with 10 cm H2O (0.98 kPA) of pressure support. ⋯ SIMV with pressure support significantly increased minute volume and ventilatory equivalent when compared with assist-control or SIMV alone, and thus was the most efficient mode of full ventilatory support for our subjects. We found no difference in ventilatory efficiency between assist-control and SIMV. All three mechanical modes were less efficient for our subjects than spontaneous breathing. The inspiratory time of 1 second used in this study, although common in clinical practice, may be inadequate for some patients.
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Comparative Study
The identification of ICU-specific outcome predictors: a comparison of medical, surgical, and cardiothoracic ICUs from a single institution.
To identify ICU-specific predictors of mortality. ⋯ We identified the presence of ICU-specific predictors of mortality amongst the three ICUs examined. These data suggest that ICU-specific interventions could be developed to improve the quality of patient care and potentially to reduce patient mortality.
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To examine the trajectory of uncertainty and symptoms of psychologic stress during the first 3 months after coronary angioplasty and coronary bypass surgery and to study the impact of social support on uncertainty and psychologic stress in these patient populations. ⋯ These results suggest that angioplasty patients may be in particular need of interventions aimed at reducing uncertainty, and that interventions that increase social support could be important in achieving this reduction.