Heart & lung : the journal of critical care
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Comparative Study Clinical Trial Controlled Clinical Trial
Relaxation technique and postoperative pain in patients undergoing cardiac surgery.
A two-group pretest and posttest quasi-experimental design was used to determine the effectiveness of a slow, deep-breathing relaxation technique in relieving postoperative pain after coronary artery bypass graft surgery. A convenience sample of 29 subjects was divided into an experimental group (n = 15), who received relaxation training on the evening before surgery and performed the technique after surgery, and a control group (n = 14), who did not receive relaxation training. Analysis of variance was used to analyze the data. ⋯ No significant differences were seen in analgesic use or visual analogue scale scores. Eleven subjects (73.3%) said the technique was helpful in their pain management. All experimental subjects stated that the relaxation technique was simple to perform, and they would recommend it to others who have postoperative pain.
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Review Comparative Study
Infection control in patients undergoing mechanical ventilation: traditional approach versus a new development--selective decontamination of the digestive tract.
Nosocomial infections are major causes of morbidity and mortality in critically ill patients. Traditional infection control practices focus on preventing infection by controlling patient exposure to microorganisms within the patient's environment. We discuss these practices, along with the factors and organisms responsible for nosocomial infection in the patient undergoing mechanical ventilation. ⋯ A new technique, selective decontamination of the digestive tract, is being studied extensively for its ability to control colonization of the oral cavity and the gastrointestinal tract. In the technique nonabsorbable topical antibiotics are applied to the oropharynx and instilled into the stomach, and a short course of an intravenous cephalosporin is included. The technique appears a worthwhile addition to traditional infection control measures.
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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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Review Case Reports
Hypervolemic hemodilution: a new approach to subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) refers to the sudden accumulation of blood in the subarachnoid space or in the ventricular system. The hemorrhage may occur with cerebral anomalies, tumors, or trauma. The presence of SAH has been associated with decreases in cerebral blood flow (CBF), which may be attributed in part to increased blood viscosity and hematocrit. ⋯ The dosage is gradually tapered before discontinuation. Effectiveness of the therapy is measured through improvement in neurologic function and regional CBF measurements. The critical care nurse plays a vital role in administering and monitoring the therapy and in educating the family about the disease process and interventions.
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Review
Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.
The administration of epidural and intrathecal narcotics is a technique of providing postoperative analgesia that is gaining popularity in many operating rooms, labor suites, and intensive care units. The epidural and intrathecal methods, first introduced a century ago, have been implemented as additional techniques for the administration of narcotic analgesics. Patients who have received epidural or intrathecal narcotics are frequently admitted to the intensive care unit for postoperative care. Because of their continuous proximity to the patient and their monitoring skills, critical care nurses are able to evaluate the analgesic effect and intervene in the event of a complication.