Critical care nursing clinics of North America
-
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.
-
Crit Care Nurs Clin North Am · Jun 2006
Review Case ReportsRecognizing and treating ischemic insults to the brain: the role of brain tissue oxygen monitoring.
This article describes the potential application of brain tissue oxygen monitoring technology in the care of patients who have sustained traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH). To accomplish this objective, a review of the intracranial dynamics that are created by primary and secondary brain injury, and the challenges of optimizing oxygen delivery to the injured brain are presented. Furthermore, interventions that facilitate cerebral oxygen supply and reduce oxygen consumption are identified. Finally, application of this technology is highlighted by using case vignettes of patients who have TBI or SAH.
-
Technologies now exist that measure carbon dioxide levels transcutaneously. Rapid assessment of patients who have depressed ventilation or suspected sepsis can improve treatment decisions including the need for admission to the ICU and pulmonary artery catheterization.
-
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.
-
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.