Heart & lung : the journal of critical care
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Randomized Controlled Trial Comparative Study Clinical Trial
Crystalloid versus colloid fluid therapy after cardiac surgery.
Differences in hemodynamic stability and fluid requirements were examined in patients randomly assigned to receive either normal saline crystalloid solution (N = 10) or hetastarch colloid solution (N = 11) after coronary artery bypass or valve operation. Both solutions were administered in the same manner for 8 hours after surgery, with hourly assessment of hemodynamic parameters and intake/output data. Infusion rates and 8-hour intake were higher for the group receiving normal saline solution (p less than 0.001), as was postoperative weight gain (p less than 0.01), although urine and chest tube outputs did not differ. ⋯ Hematocrits on postoperative day 1 were lower in the group given hetastarch (p less than 0.001), suggesting prolonged intravascular expansion. The subjects given hetastarch also required significantly less time in the intensive care unit (p less than 0.001). Thus, cardiac surgical patients receiving colloids exhibited reduced fluid requirements, superior hemodynamic performance, and shortened intensive care stay when compared with those given crystalloid resuscitation.
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Randomized Controlled Trial Clinical Trial
Retention of cardiopulmonary resuscitation skills among nursing personnel: what makes the difference?
The American Association of Critical-Care Nurses' Position Statement on cardiopulmonary resuscitation (CPR) certification states that "nurses who care for the critically ill must have annual BCLS or CLS certification...." Review of literature, however, did not reveal any studies among nurses that examined the question of whether Basic Cardiac Life Support (BCLS) was superior to other forms of CPR education, such as Basic Life Support-A (BLS-A) (Heartsaver). The purpose of this 2 by 3 factorial design study was to examine the relationship between the method of instruction and the quality of retention of one-person CPR skills at 4 and 8 months after the initial class. The two methods of instruction under consideration were a BLS-course A (hospital-wide Heartsaver course) and a BLS-course C (Basic Cardiac Life Support course). ⋯ Other variables that were described in the literature were education, practice of skills, current position, years in profession, previous CPR training, motivation, and felt level of competence. These variables also were included in the study to find out the total variable impact on CPR retention. At least 30 registered nurses were selected from each of the high, medium, and low use areas and randomly assigned to one of the instruction groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Effects of lung hyperinflation on mean arterial pressure and postsuctioning hypoxemia.
Our purpose was to determine the effect of five different lung hyperinflation volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, and 18 cc/kg lean body weight) on mean arterial pressure and postsuctioning hypoxemia (arterial blood gases). Subjects received three consecutive lung hyperinflations at one of the five randomly ordered volumes in 15 seconds via a ventilator "sigh" control at a fraction of inspired oxygen of 1.0. The three lung hyperinflations were followed by 10 seconds of continuous suction (flow rate 16 L/min). ⋯ The sample consisted of eight men and women 4 hours after coronary artery bypass graft surgery. Data indicated a statistically significant (by analysis of variance, p = 0.000) mean increase of 15 mm Hg in mean arterial pressure over the three lung hyperinflation sequences that was not volume dependent. There was a significant increase (p = 0.0001) in arterial oxygen pressure at 0 seconds after suctioning that increased with each increasing lung hyperinflation volume.