Critical care nursing quarterly
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In addition to improving gas exchange by mechanical ventilation, minimizing iatrogenic lung injury and making the patient comfortable are important goals. This article reviews advanced ventilator modes and techniques that might help to accomplish these goals. Small tidal volumes (VT) and low ventilation pressure minimize ventilator-induced lung injury. ⋯ Certain ventilator modes purport to automate part of the ventilator discontinuance process. The ASV progressively reduces support as the patient's lung condition improves, while SmartCare/pressure support (Dräger, Lübeck, Germany) reduces support and then initiates a spontaneous breathing trial. Further research is required to determine the proper place these new modes have in the intensive care unit.
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Prone positioning has been used as a treatment option for patients with acute lung injury or acute respiratory distress syndrome (ARDS) since the early 1970s. Prone position and extended prone position ventilation have been shown to increase end-expiratory lung volume, alveolar recruitment, and oxygenation in patients with severe hypoxemic and acute respiratory failure. Prone positioning is not a benign procedure, and there are potential risks (complications) that can occur to both the patient and the health care worker. ⋯ Prone positioning is a viable, inexpensive therapy for the treatment of severe ARDS. This maneuver consistently improves systemic oxygenation in 70% to 80% of patients with ARDS. With the utilization of a standardized protocol and a trained and dedicated critical care staff, prone positioning can be performed safely.
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To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. ⋯ Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings.
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Safety and quality improvement are major issues in children's hospitals. Improving pediatric medication safety often takes on a larger role in pediatric units than in adult units due to the larger size differences and dose ranges found in a pediatric intensive care unit. This article reviews the literature and our own experience at the CS Mott Children's Hospital, University of Michigan, to improve medication safety. The issues identified include (1) an effective pediatric medication safety governance structure within a larger hospital, (2) practice standardization strategies for physicians, nurses, and pharmacists, (3) use of pharmacy technicians as unit medication managers, which reduces medication costs and decreases nursing time spent hunting for medications, and (4) methods to improve the safety culture in a pediatric intensive care unit.
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For more than a decade, research has demonstrated both the widespread prevalence and negative outcomes associated with intensive care unit delirium. Hospitals are, therefore, being called to institute evidence-based protocols to prevent and manage its occurrence. Integrating evidence-based practice into bedside care can be a challenge. ⋯ This approach has been proven successful in reduction of ventilator-associated pneumonias and catheter-related blood stream infections, while in partnership with Johns Hopkins University. The purpose of this article is to describe the creation of evidence-based toolkits used to facilitate successful statewide changes in practice using an interprofessional team including nurses, physicians, and pharmacists. The content reflects a step-wise approach to not only engage and educate staff, but also strategies to execute and evaluate the effectiveness.