Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 2006
ReviewEnd-tidal carbon dioxide monitoring: a VITAL sign worth watching.
Capnography is the monitoring of end-tidal carbon dioxide in waveform and numeric display. For this technology to be useful, the critical care nurse must have a clear understanding of the normal capnography waveform and what the alterations in this waveform represent. The critical care nurse can use this information to plan patient care interventions with other critical care team members and to adjust care based on the patient's response. End-tidal carbon dioxide physiology, normal waveforms, abnormal waveforms, and clinical aspects of capnography monitoring are included.
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Crit Care Nurs Clin North Am · Jun 2006
ReviewArterial pressure-based technologies: a new trend in cardiac output monitoring.
New trends in cardiovascular monitoring use the arterial pulse as a less invasive means of assessing cardiac output. When adopting a new technology into practice, three questions need to be answered: (1) is the method technologically sound?, (2) is it based on physiologic principles?, and (3) are the applications clinically important? This article provides a clinical review on the technology, physiology, and applications of a new arterial pressure-based method of determining cardiac output and stroke volume variation as an additional parameter for fluid status assessment.
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Traditionally, bedside evaluation of tissue oxygenation has been accomplished by assessing mixed venous oxygen saturation (SvO2) using a fiberoptic pulmonary artery catheter. It may not always be feasible to place a pulmonary artery catheter early in resuscitation or outside of the ICU. Introduction of continuous central venous oxygen saturation (ScvO2) monitoring that uses a modified, central venous catheter is making it possible to evaluate ongoing tissue oxygenation in nontraditional settings, such as the Emergency Department. Continuous measurement of ScvO2 will alert the clinician to major derangements in oxygen balance, which allows for timely implementation of appropriate interventions.
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In 2002, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) reviewed 23 reports of death or injury that were related to mechanical ventilation. Nineteen of those events resulted in death, and 4 resulted in coma; 65% were related to alarms. ⋯ This review prompted JCAHO to include alarm safety in the National Patient Safety Goals for 2003. This article examines the components of an alarm safety program, from the complex to the common sense.
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Crit Care Nurs Clin North Am · Jun 2006
Impact of bispectral index monitoring on sedation and outcomes in critically ill adults: a case series.
In situations in which clinical assessment of sedation level is compromised, such as deep sedation/analgesia with and without neuromuscular blockade (NMB), electroencephalogram-based monitoring may potentially assist in achieving balance between inadequate and excessive levels of sedation. To validate the bispectral index (BIS) for use in clinical practice, correlation and possible differences in outcome using clinical assessment versus clinical assessment augmented by electroencephalogram-based monitoring were determined. BIS monitoring was decisive in ICU care in 9 of 15 patients in this series. The most significant potential benefit was obtained in the subset of patients receiving NMB.