Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 1999
Review Case ReportsMaking weaning easier. Pathways and protocols that work.
Clinical pathways and weaning protocols are useful tools for improving the care of patients requiring LTMV. The value of the pathways and protocols rests in large part on the systematic multidisciplinary nature of the tools. ⋯ The success of such care delivery models rests with the quality of those who design, test, and revise them. If developed in a careful and thoughtful manner using the best science available, the pathways and protocols may truly be powerful tools for clinical practice.
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Advances in technology now permit a variety of noninvasive respiratory monitoring options for clinicians. Perhaps a more complex issue is determining how much monitoring is needed as part of routine patient care. Often, practitioners take a "more is better" approach. ⋯ The fact that many aspects of cardiopulmonary assessment can now be determined noninvasively is an important advantage over more invasive technologies and their associated risks. Clearly, monitoring techniques such as pulse oximetry and capnography do not eliminate the need for arterial blood gases and other invasive cardiopulmonary monitoring techniques. Rather, when appropriately applied, noninvasive monitoring has the potential to reduce the frequency of certain invasive procedures and still provide valuable information to nurses and other health care practitioners.
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Crit Care Nurs Clin North Am · Dec 1999
Review Case ReportsClinical application. Using oxygenation profiles to manage patients.
Cellular oxygenation is dependent on both tissue oxygenation and pulmonary oxygenation. The use of profiles can help to make the assessment of tissue and pulmonary oxygenation more thorough. ⋯ Oxygenation profiles enable the nurse to trend a patient's progress and response to nursing and medical interventions. A sophisticated assessment relies not merely on physical assessment alone but incorporates continuous mixed venous oxygenation and oxygenation profiles to assess a patient's tissue and pulmonary oxygenation status.
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Crit Care Nurs Clin North Am · Dec 1999
ReviewNew strategies for mechanical ventilation. Lung protective ventilation.
Although research is ongoing, and there are no definitive data to mandate the final answer to the question of which ventilation strategies result in the most optimal outcomes, the consensus of clinicians today suggests that we limit FIO2 to nontoxic levels, limit ventilating pressures and volumes, and use PEEP levels adequate to recruit alveoli and prevent tidal collapse. The critical care nurse must remain vigilant in his or her review of current literature to maintain knowledge of the current recommendations for optimal MV strategies.
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Crit Care Nurs Clin North Am · Dec 1999
ReviewVentilatory strategies for the critically ill infant and child.
As newer modes of mechanical ventilation and adjuncts to ventilation continue to be developed and studied, pediatric critical care practitioners are going to have many exciting options for the treatment of the critically ill infant and child. All who provide care to these critically ill patients must continue to evaluate these varied ventilatory strategies.