Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 1999
ReviewManagement of patients with acute respiratory distress syndrome.
Acute respiratory distress syndrome is a complex clinical syndrome of respiratory failure that presents a challenge to every critical care team. Since the first clear description by Ashbaugh et al more than 30 years ago, much has been learned about the pathophysiologic process that occurs within the lungs after they suffer either a direct or indirect injury. Unfortunately, little success has been achieved in improving outcomes; however, hope is on the horizon. Current research evaluating optimal ventilator management, ECMO, the use of inhaled nitric oxide, and other experimental management strategies will hopefully combine to produce improved outcomes.
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Crit Care Nurs Clin North Am · Jun 1999
ReviewManagement strategies for improving outcome following severe head injury.
Severe head injury is a major cause of disability, death, and economic cost. Significant reductions in mortality and morbidity can be achieved in patients with severe head injury through the use of evidence-based protocols and guidelines. Although no set standard is available for the management of patients with severe head injury, improved outcomes following severe head injury are seen with complete and rapid physiologic resuscitation and specific strategies that decrease ICP.
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The GI tract is an important line of defense in the body's immunologic system. Without the proper care and treatment, this defense fails, rapidly increasing critically ill patients' susceptibility to added infections and system failures. ⋯ As more research is completed, the role of the GI tract in critical illness and measures to maintain its integrity will be identified. In the meantime, the initiation of enteral nutrition is an important initiative.
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Crit Care Nurs Clin North Am · Jun 1999
Outcomes improvement following minimally invasive direct coronary artery bypass surgery.
The most progressive movement in the standardization of MIDCAB has occurred within the past 5 years. Standardization of care and continuous quality improvement are essential to improve outcomes and reduce costs for MIDCAB. At the authors' institution, perioperative clinical outcomes demonstrated no significant differences among a traditional single-vessel CABG and a MIDCAB in myocardial infarction rates, reoperations for bleeding, and cerebrovascular accidents. ⋯ The reported clinical outcomes are appropriate variables to track for continuous quality improvement. These clinical outcomes are meaningful, measurable, and appropriate for evaluating the effectiveness of care but do not address quality of life, patient satisfaction, and efficacy of pain management. Nursing care must continue to evolve as more data become available.