Critical care nursing quarterly
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Preventing hospital-acquired infections, including ventilator-associated pneumonia (VAP), has become a priority for Wyoming Medical Center. Despite the implementation of a standardized care bundle protocol to reduce the facility's high rate of VAP, rates of VAP remained higher than the national benchmark. ⋯ The VAP committee implemented a VAP bundle protocol and adopted the use of a polyurethane endotracheal tube on the basis of literature review. These interventions, in addition to comprehensive education and the synergism between physicians, nurses, and respiratory therapists, have not only reduced the center's VAP rate but also prevented the occurrences of VAP during 33 consecutive months.
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Hyperbaric oxygen therapy has a rich and diverse history, both in the United States and around the world. From its early uses in war to the building of bridges, and through many introductions to innovations in the medical community, it has been debated and modified until its ultimate acceptance in multiple areas of patient care. Numerous areas of patient care use hyperbaric therapy, from wound care to military applications, in both single monoplace chambers and multipatient settings in larger chambers. This article provides an overview on the history, trial and error, and modern development of hyperbaric oxygen in clinical care therapies in 21st century medicine and nursing.
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Hyperbaric oxygen therapy has been approved for primary or adjunctive care in 14 indications. A hyperbaric environment exists when a patient's whole body is physically exposed to 100% oxygen and pressure that is greater than one atmosphere absolute. ⋯ Hyperbaric therapy works through several different mechanisms in the crush injury. Effects of hyperoxygenation, reduction of edema, infection control enhancement, blood vessel and collagen formation, and reduction of free radicals and reperfusion injury help in healing in patient with crush injuries.
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The varied clinical applications for hyperbaric oxygen therapy have led to the development of a unique, highly skilled nursing specialty of hyperbaric nursing. The ever-increasing availability of hyperbaric medicine and the broadening scope of clinical indications have fueled the need for highly skilled hyperbaric nurses.
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Anesthetic management of patients who have suffered traumatic brain injuries can be challenging. We investigated the relationship between arterial to end-tidal carbon dioxide partial pressure gradients (Pa-etCO₂) and 3 predictor variables: (1) injury severity score, (2) use of positive end-expiratory pressure, and (3) presence of rib fractures. Using a convenient sampling method, we sampled 56 patients who arrived to the operating room intubated after traumatic brain injuries between 2005 and 2011. ⋯ This study identified coexisting conditions in which the patients' Pa-etCO₂ gradients were large. Results showed that injury severity score of 30 or more, the presence of rib fractures, and higher body mass index were statistically significant predictors of Pa-etCO₂ gradients greater than 10 mm Hg. These observations should be considered when evaluating PetCO₂ in conjunction with arterial blood gas analysis to determine optimal ventilation status of these patients.