Critical care nursing quarterly
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Liver transplantation is an acceptable treatment modality for complications of end-stage liver disease from chronic and acute liver failure. In the United States, 16 377 people are currently awaiting liver transplant but only 6492 transplantations were performed in 2007. ⋯ Common postoperative complications include graft dysfunction, vascular thrombosis, biliary tract complications, infection, rejection, neurologic injury, electrolyte imbalances, and drug interactions. A multidisciplinary approach to care including the critical care nurse is necessary for successful long-term outcomes.
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Significant pulmonary complications are prevalent in intubated and mechanically ventilated patients. ⋯ Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.
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More than 92000 Americans are on waiting lists for organ transplants, and an average of 17 of them die each day while waiting. The US Organ Donation Breakthrough Collaborative (ODBC), which began in 2003 at the request of the Secretary of the US Department of Health and Human Services, was a formal, concerted effort of the donation and transplantation community to bring about a major change to improve the organ donation system. The nationwide Collaborative was housed within a Health and Human Services agency, the Health Resources and Services Administration (HRSA) Division of Transplantation, and included participation of the organ procurement organizations (OPOs) throughout the United States and the American hospitals with the largest organ-donor potential. ⋯ Between October 2003 and September 2006, the number of total US organ donors increased 22.5%, an increase 4-fold greater than the 5.5% increase measured over the same number of years in the immediate pre-Collaborative period. The study did not involve a randomized design, but time-series analysis using statistical process control charts shows a highly significant discontinuity in the rate of increase in participating hospitals concurrent with the Collaborative program, and strongly suggests that the activities of the Collaborative were a major contributor to this increase. Given the stable nature of the historical increases over many years, the HRSA estimates that more than 4000 annual additional transplants have occurred in association and apparently as a result of these increases in organ donation.
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Sepsis poses a major threat to patient safety in intensive care units (ICU) across the country. An accumulating body of evidence supports using established protocols to screen ICU patients regularly for sepsis indicators; however, there often is a gap between what is known and what is practiced. Compliance with sepsis screening was noted to be less than acceptable at one Regional Michigan Medical Center. ⋯ A 1-group pretest-posttest quasi-experimental design was used for the study. A nonprobability, convenience sample of patient charts from a 16-bed ICU in a 352-bed regional referral center was used for the study. Findings from this study demonstrated that the introduction of nurse champions significantly improved compliance with ICU sepsis screening, from 23% preintroduction to 74% postintroduction, but had virtually no effect on patient outcomes related to percentage of patients treated for sepsis.
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If advanced cardiac life support therapy fails to revive a patient, extracorporeal life support (ECLS) becomes a critical bridge that maintains total systemic circulation and oxygenation during cardiac arrest or severe respiratory failure and allows time to establish a treatment plan. Improved patient outcomes depend on a shorter time period from the start of advanced cardiac life support to the initiation of ECLS. An in-house critical care nurse response team facilitates rapid initiation of ECLS, often in less than 20 minutes, at any time in any area of the hospital. ⋯ The system used for rapid and mobile initiation of ECLS maintains perfusion to the vital organs via a centrifugal flow pump, using a hollow-fiber membrane oxygenator and percutaneous cannulas. Team members prime the system while the ECLS-trained first-response physicians place cannulae. All elements of program development, team education, and ongoing program maintenance are critical to successful outcomes for patients.