Heart & lung : the journal of critical care
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To describe the clinical outcomes and cost for high-risk critical care patients with peripherally inserted central venous catheters (PICCs). ⋯ When subjects were in critical care areas, catheters remained in place a mean of 10 days with a range of one to 50 days. After patient transfer with catheters in place to acute care areas (medical-surgical units), convalescent units, and home care, catheters were maintained a mean of 13 days with a range of 1 to 116 days. Catheter days totaled 2069. The total number of catheter days while in critical care were 878, with 1191 catheter days after transfer to other areas. Seventy-one of the original 92 PICC catheters remained in place until treatment was completed or the patient expired. Twenty-one were removed for nonelective reasons. Of these patients, only one had significant morbidity related to sepsis. This septic episode occurred in a convalescent unit. Percentage of catheter-related sepsis was 0.48% per 1000 catheter days. Because PICCs are not used to any degree in critical care patients throughout the United States, this study should increase awareness among practitioners that this approach is a safe alternative method to chest or neck insertion for central venous access in high-risk critical care patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
A pilot study of pain, analgesia use, and pulmonary function after colectomy with or without a preoperative bolus of epidural morphine.
To determine whether patients who received a preoperative bolus of epidural morphine plus postoperative parenteral analgesia had less pain and better pulmonary function over the first 2 days after a colectomy than patients who received postoperative parenteral analgesia alone. ⋯ Results should be confirmed through study of a larger sample with the hypothesis that pain relief, selected aspects of pulmonary function, and peripheral oxygenation may be superior for patients who receive a preoperative bolus of epidural analgesia for abdominal surgery.
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Critically ill patients have greater than normal oxygen demands because of enhanced energy requirements placed on them by the stress of acute illness, blood and fluid loss, surgery, wound healing, and hospitalization. Early recognition of major alterations in oxygen transport variables, oxygen delivery, oxygen consumption, and the oxygen extraction ratio, by the critical care team assists in the prevention and treatment of tissue hypoxia in seriously ill and injured patients. ⋯ When deviations from supranormal values of oxygen transport variables in these patients are identified, specific interventions that improve oxygen delivery to peripheral tissues should be implemented and evaluated for their effectiveness in normalizing the oxygen extraction ratio. When serial measurements of oxygen delivery, oxygen consumption, and the oxygen extraction ratio follow each therapeutic intervention that is directed at increasing oxygen delivery, the survival rate of critically ill patients is significantly improved.
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To identify which behaviors performed by emergency department nurses were perceived by patients as important indicators of caring. ⋯ Patients experience nurse caring behavior most consistently from the technical aspects of nursing care.
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Randomized Controlled Trial Clinical Trial
Spotlight article: pulse oximetry in the postoperative care of cardiac surgical patients: a randomized clinical trial. (Bierman MI, Stein KL, Snyder JV. Chest 1992; 102: 1367-70.).
Despite the limitations noted in this critique, the study provides information regarding the usefulness of pulse oximetry in care of postoperative cardiac surgery patients. Similar studies could be done with other groups of critically ill patients. Evaluation of technology in the critical care setting is essential so that care can be rendered in the safest and most efficient, cost-effective, manner.