Critical care nursing clinics of North America
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Approaches to mechanical ventilation (MV) are consistently changing and the level of ventilator sophistication provides opportunities to improve pulmonary support for critically ill patients. Advanced MV modes are used in the treatment of patients with complex pulmonary conditions. ⋯ It's essential for nurses to integrate pulmonary MV knowledge in the care of critically ill patients. The purpose of this article is to describe the evidence supporting lung protective modes of MV used in the care of critically ill adults.
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Crit Care Nurs Clin North Am · Sep 2012
Self/unplanned extubation: safety, surveillance, and monitoring of the mechanically ventilated patient.
The purpose of this article is to provide an appreciation for a significant risk to quality of care affecting patients receiving mechanical ventilation: unplanned extubation. A summary of the current literature provides evidence-based recommendations for how to minimize this potentially dangerous complication. In addition, recommendations for proceeding after unplanned extubation are made.
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It is estimated if each hospital implemented intensivist physician staffing, approximately 55,000 lives and $4.3 billion dollars could be saved in the United States. However, there is a limited supply of new critical care specialists as teaching hospitals have decreased the size of critical care programs for financial reasons. Tele-ICU can be used to provide coverage in facilities that cannot support a full-time specialist in critical care medicine and as an adjunct to facilities without 24-hour intensivist coverage. This article discusses the benefits and challenges of tele-ICU and its implications for nursing practice.
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Crit Care Nurs Clin North Am · Sep 2012
Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease.
Pneumonia affects millions of people every year in the United States. Hospital-acquired pneumonia is associated with a mortality rate as high as 50%. Pneumonia is classified according to where it was acquired or by the infecting organism. This article explores the similarities and differences in three types of pneumonia seen routinely in the intensive care unit: community-acquired pneumonia, ventilator-associated pneumonia, and health care-associated pneumonia.
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Chronic obstructive pulmonary disease (COPD) is characterized by expiratory airflow limitation that is not fully reversible. Acute exacerbations in patients with moderate to severe COPD can cause severe hypoxia and persistent or severe respiratory acidosis, resulting in respiratory failure and the need for ventilator support. ⋯ Noninvasive and invasive ventilator support in conjunction with pharmacotherapy can be lifesaving, although mortality remains high. It is important also to consider pulmonary rehabilitation and palliative care.