Heart & lung : the journal of critical care
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of normal saline and heparin solutions for maintenance of arterial catheter patency.
A double-blind, randomized study was conducted in 30 adult medical intensive care unit patients to determine if the presence of heparin in continuous-flush solutions prolongs the functional life span of radial arterial catheters compared with catheters flushed with solutions not containing heparin. Patients were consecutively entered into the study and randomly assigned to receive arterial line flush solutions containing 0.9% sodium chloride (NSS) or heparin 4 U/ml in 0.9% sodium chloride. ⋯ In addition, the heparin-flushed catheters required significantly less manipulation to prevent catheter occlusion and arterial pressure-wave dampening (p less than 0.01). The use of NSS as a continuous flush for radial artery catheters is associated with an increased frequency of catheter occlusion and malfunctions compared with solution containing heparin, and thus is not recommended in patients with normal coagulation status and platelet count.
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Comparative Study
Preoperative pulmonary status and postoperative extubation outcome of patients undergoing elective cardiac surgery.
The purpose of this study was to determine whether factors associated with impaired pulmonary function were predictive of postoperative extubation outcome (extubation according to protocol or delayed extubation) in a sample of patients undergoing elective cardiac surgery. Forty-seven patients were assessed before surgery and after postoperative extubation using a noninvasive assessment technique. Positive preoperative affect was the sole factor associated with extubation outcome in this sample of patients undergoing cardiac surgery. ⋯ Subjects with delayed extubations had a greater incidence of postoperative atelectasis (p = 0.02). They also had significantly longer stays in the surgical intensive care unit (p = 0.01) and the hospital (p = 0.05). Preoperative pulmonary function, age, sex, and history of smoking were not associated with postoperative extubation outcome.
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Family needs research has for the most part focused on the families' perceptions when a significant other is admitted to the intensive care unit. We examined critical care nurse perceptions of family needs. The questionnaire "Needs of Families of Critically Ill Patients" was given to 126 intensive care unit nurses. ⋯ Cognitive family were ranked higher than psychologic or personal and physical needs. Nurses from the four intensive care units ranked family needs significantly differently, a result that may be influenced by differing patient acuity and patient length of stay on individual units. Nurses' perceptions of family needs were influenced by units worked, length of time practicing in critical care, educational preparation, and length of time in nursing.
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Nurses prepare patients for chest tube removal, yet little has been written to indicate the sensations to be expected during this routine procedure. The sensations reported by patients and factors that could influence those sensations were examined in this study. The sample consisted of 36 patients after thoracic surgery (24 men and 12 women), all of whom were scheduled to have either a mediastinal or a pleural tube removed. ⋯ The sensations were similar for the old and young subjects with younger subjects reporting higher intensities. Women reported pain more frequently than men, but the intensities of the sensations reported by men and women were not significantly different. The sensations reported during chest tube removal differ from those described in the literature and can be used to prepare patients more appropriately for chest tube removal.
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Review Case Reports
Treatment strategies in shock: use of oxygen transport measurements.
Shock has traditionally been categorized according to its cause. Shock can result from hemorrhage, primary cardiac failure, central nervous system failure, trauma, or sepsis. Therapeutic principles have been developed for each etiologic type. ⋯ These variables are easily calculated by using data obtained from pulmonary artery catheter and laboratory measurements. The physician or nurse caring for critical ill patients should have a thorough understanding of the rationale for the use of oxygen transport calculations and the methods of manipulating oxygen delivery. A simple explanation of these principles including the importance of hemoglobin, cardiac index, and percent saturation of hemoglobin and suggested treatment strategies are presented.