Critical care nursing clinics of North America
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This article has reviewed some of the current airway management practices as well as technologic advances in adult tracheal tube design in the critically ill patient. Although the primary goals of airway protection and facilitation of positive pressure ventilation remain unchanged, a better understanding of the limitations of tracheal tubes, as well as strategies for optimized airway management, is critical. Such information is needed in order to reduce or avoid potential complications associated with tracheal tubes or similar airway devices.
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsContinuous mixed venous (SvO2) monitoring. Too expensive or indispensible?
Based on theoretic principles and clear literature support, SvO2 (mixed venous oxyhemoglobin) monitoring offers an important advantage over traditional hemodynamic parameters. SvO2 allows more precise understanding of the adequacy of cardiac and pulmonary function than traditional parameters. SvO2 values do not replace the need to measure individual parameters of oxygen delivery or consumption but serves as the standard for assessing the impact of each parameter on tissue oxygenation. ⋯ The cost-effectiveness of the catheter, like any technology, is predicated on the clinician. Clinicians++ must be educated to use SvO2 as a primary end point for treatment decisions regarding hemodynamic therapy and patient stability. If used properly, every PAC should use fiberoptic SvO2 capabilities.
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsCapnography. A key underutilized technology.
Based on the multiple applications and the potential cost savings, every ICU should have enough capnography for all intubations and probably for all mechanically ventilated patients. Of the multiple clinical applications of capnography, most attention should be focused on its use with intubation and resuscitation. Other applications, such as blood gas and ventilation-perfusion scan reduction, should be instituted after the primary areas have been implemented. While capnography modules may appear to be expensive at first glance, an analysis of their clinical application reveals they can save the hospital hundreds of thousands of dollars beyond the purchase price.
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Pulse oximetry is one of the most commonly applied technologies in acute and critical care. It has the potential to continuously monitor pulmonary function, avoid unnecessary blood gases, and alert clinicians to hypoxemic events that are not readily apparent by physical assessment. Due to these advantages, pulse oximetry has a firm place in health care. ⋯ In addition, oximetry has the potential to be misused owing to its widespread application. In order to obtain the maximum benefits from this technology, clinicians must be educated about the strengths and limitations of oximetry. If this education effectively changes clinicians' behavior, pulse oximetry will provide an excellent clinical advantage in patient assessment as well as moderate cost benefits.
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Crit Care Nurs Clin North Am · Mar 1999
ReviewAdvances in continuous, noninvasive hemodynamic surveillance. Impedance cardiography.
In the current climate of shrinking health care reimbursement and increasing importance of patient centered care, impedance cardiography is one method of enhancing quality of patient care and appropriate use of resources. Hemodynamic and thoracic fluid status data may be obtained quickly, accurately, and without risk, providing a global clinical perspective. ⋯ Application of a technology assessment model to impedance cardiography illustrates the utility of this method of hemodynamic monitoring. Careful review and critique of the literature differentiates the available impedance technologies, supports use in areas not traditionally associated with hemodynamic monitoring, such as the home and emergency department, and validates the use of impedance cardiography in place of, or as an indication for, pulmonary artery catheterization.