Critical care nursing quarterly
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Technology utilization in the cardiac surgical patient has proliferated, despite a lack of evidence that the technology has a positive impact on patient outcomes. Hospitals are left to their own efforts in deciding how and what technology to use. The result is an inconsistent use of technology. ⋯ Two controversial technologies, capnography and mixed venous oxygen saturation monitoring, are analyzed using this approach. It is essential for hospitals to support clinicians as they use methods in the evaluation and implementation of technology. Technology alone will not improve patient outcome or control costs.
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Latex allergy affects about 1% of the general population and between 10% and 17% of health care workers. The severity of a latex allergic reaction can range from contact dermatitis to anaphylaxis and death. ⋯ In addition, knowledge and provision of emergency treatment of a Type I latex reaction is paramount. Critical care staff need to educate both the patient and the family about latex allergy, including latex allergy testing and community resources.
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Review Case Reports
Outcomes manager: brain death criteria in the pediatric patient.
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This article presents an overview of the varied modes of ventilation and supportive adjuncts for the pediatric patient. Ventilatory management has changed over the past few decades with the advent of high-frequency ventilation, pressure control-inverse ratio, pressure-regulated volume control, volume support, noninvasive bi-level pressure ventilation such as BiPAP, and the emergence of adjuncts to improve oxygenation such as surfactant, extracorporeal membrane oxygenation, nitric oxide, and total and partial liquid ventilation. Ventilatory management of pediatric patients mandates an armamentarium including guided imagery and the use of speech enhancers. A multidisciplinary team approach is essential.
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New management options for acute respiratory failure aim at avoiding ventilator-induced lung injury while maintaining adequate gas exchange. Selected approaches examined in this article include methods to augment carbon dioxide elimination with tracheal gas insufflation, venovenous extracorporeal carbon dioxide removal, and intravascular oxygenation. Improving oxygenation can be accomplished by judicious use of positive end-expiratory pressure, venoarterial extracorporeal membrane oxygenation, and pharmacologic intervention with inhaled nitric oxide.