Heart & lung : the journal of critical care
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The primary purpose of this study was to determine whether a modified Norton scale at admission to the hospital would predict which patients would develop pressure ulcers when hospitalized for surgery for a period of up to 3 weeks. The sample was composed of 387 adult patients admitted for elective cardiovascular surgery or neurosurgery. By regression analysis, no difference was found in the modified Norton scale scores for those who did and those who did not have pressure ulcers during hospitalization. ⋯ The knee and lateral malleolus were the sites of the most severe pressure ulcers. Subjects who were hospitalized for longer periods had more severe ulcers. Future research is needed to more precisely determine which patients in the acute care setting are at risk for the development of pressure ulcers.
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Patients with central nervous system trauma frequently have fevers while in the neurosurgical intensive care unit. Temperature elevations in the neurosurgical patient often cause much diagnostic confusion, and little is written that assists the critical care team in arriving at a proper etiologic diagnosis for the fever. ⋯ The recognition of central fevers, posterior fossa syndrome, and drug fevers is particularly important in neurosurgical patients to avoid inappropriate and potentially dangerous treatment with unnecessary antimicrobial therapy. Clinical and laboratory clues provide the clinician with a diagnostic approach to fever in the neurosurgical intensive care setting.
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Limited data are available on the efficacy of a common endotracheal suctioning intervention to prevent postsuctioning decreases in arterial oxygenation (PaO2). This study evaluated the effect on Pao2 of five hyperinflation (tidal volume 1.5 times normal) and hyperoxygenation breaths, administered before and after each of two consecutive endotracheal suctioning passes, with use of a manual resuscitation bag (PMR-2 model). The convenience sample consisted of 32 patients with endotracheal tubes who were observed within 24 hours of coronary artery bypass surgery. ⋯ In addition, a clinical measure of alveolar-capillary gas exchange (PaO2/PAO2 ratio) was found to be a significant predictor of PaO2 after suctioning, accounting for 38% of the variance. The data from this study support the efficacy of administering five hyperinflation and hyperoxygenation breaths, with use of a manual resuscitation bag, before and after endotracheal suctioning in stable patients after coronary artery bypass surgery. Further study is necessary to determine the efficacy of this suctioning intervention in patients with other respiratory problems.
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Closed system suctioning (CSS) is a method of removing secretions from the tracheobronchial tree of patients with mechanical ventilation without disconnecting the mechanical ventilator. The putative benefits of CSS include the maintenance of positive pressure ventilation, oxygen supply, and positive end-expiratory pressure (PEEP). However, some evidence indicates that negative airway pressure may develop during CSS if inappropriate ventilator settings are selected. ⋯ During each suctioning trial, the peak positive and negative airway pressures were recorded. The negative airway pressure was above -10 cm H2O in most situations. In the control mode at all flow rates with or without PEEP, the Bennett MA1 and the Bourns-Bear 1 and 2 produced sustained peak negative airway pressure of less than -50 cm H2O.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patients undergoing cardiac surgery are mildly hypothermic by the completion of the surgical procedure. They need to return to a normothermic state if enzymatic functions are to proceed in their normal manner. The body can produce heat by elevating metabolic rate or by activating the shivering mechanism. ⋯ External methods, which minimize additional heat loss, include the use of warming lights, elevation of room temperature, and the use of blankets. Internal methods, which transfer heat by convection, may be used to help actively reverse hypothermia. Such techniques include warmed inhalation gases and intravenous fluids, warmed nasogastric lavage fluid, and warmed peritoneal dialysis fluid for patients with end-stage renal failure with severe electrolyte disorders after surgery.