Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2004
The experience of four outcomes managers: an institutional approach to weaning patients from long-term mechanical ventilation.
Care of patients requiring long-term mechanical ventilation (LTMV) is the focus of many hospitals nationwide. Because the care of patients who require LTMV is complex and morbidity and mortality are high, associated costs often exceed reimbursement. This article describes a successful institutional program for the care of the patient population requiring LTMV using advanced practice nurses (APNs) in the role of outcomes managers (OMs). So that others may benefit from the experiences of the clinicians, this article describes the historical background, the selection and qualifications of APNs, the process APNs use to manage and monitor the patients, role challenges, and associated outcomes.
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Asthma is a chronic inflammatory disorder that results in recurrent episodes of reversible airflow obstruction. Lung hyperinflation results from obstruction or dynamic airway collapse during exhalation. ⋯ Patients who present with asthma have increased inspiratory work of breathing due to lung hyperinflation and auto-positive end-expiratory pressure (auto-PEEP). The goal of acute care treatment is to reverse bronchoconstriction and inflammation, thus reducing dynamic hyperinflation, so that breathing is restored to baseline, unlabored, quiet breathing.
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Weaning patients from long-term mechanical ventilation continues to be a goal of clinicians and scientists and the hospitals charged with their care. This article describes the science of the "wean" and the "how" of weaning. A goal of scientists has been to develop predictors that determine accurately the optimal time to initiate weaning. ⋯ Quite simply, predictors do not predict. In contrast, methods that decrease variation in care practices have demonstrated positive outcomes. The methods include protocols for weaning trials and sedation and other system initiatives inclusive of a multidisciplinary plan of care or clinical pathway.
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Crit Care Nurs Clin North Am · Sep 2004
ReviewPreventing ventilator-associated pneumonia: evidence-based care.
Ventilator-associated pneumonia is a common complication of mechanical ventilation with significant morbidity and mortality. This article summarizes the data related to specific risk factors associated with ventilator associated pneumonia (patient position, oral health, airway management, and gastrointestinal factors) and provides recommendations for practice based on the present evidence.
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Crit Care Nurs Clin North Am · Sep 2004
Review Case ReportsCaring for the bariatric patient with obstructive sleep apnea.
Caring for the bariatric patient in the acute care environment poses many challenges to the team delivering care. The management of obstructive sleep apnea with noninvasive ventilation is one priority. Treatment options, including bi-level ventilation and continuous positive airway pressure, and delivery strategies are reviewed in conjunction with other aspects of care that ensure a holistic, comprehensive plan of care. The most effective plan of care for the bariatric patient is one that uses a multidisciplinary coordinated team effort.