Critical care nursing clinics of North America
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Functional components of the microcirculation provide oxygen and nutrients and remove waste products from the tissue beds of the body's organs. Shock states overwhelmingly stress functional capacity of the microcirculation, resulting in microcirculatory failure. ⋯ In nonseptic shock states, the microcirculation is better able to compensate for alterations in vascular resistance, cardiac output, and blood pressure. Therefore, global hemodynamic and oxygen delivery parameters are appropriate for assessing, monitoring, and guiding therapy in hypovolemic and cardiogenic shock but, alone, are inadequate for septic shock.
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Crit Care Nurs Clin North Am · Sep 2014
ReviewMonitoring tissue blood flow and oxygenation: a brief review of emerging techniques.
This article describes promising emerging technologies developed for measuring tissue-level oxygenation or perfusion, each with its own inherent limitations. The end user must understand what the instrument measures and how to interpret the readings. ⋯ Assessment of the metabolic state of the extracellular space with existing technology and proxy indicators of metabolic status are discussed. Also addressed are potential sources of variation for each technique, and the role that the clinician plays in the proper interpretation of the data.
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Maintenance of brain perfusion and oxygenation is of paramount importance to patient outcome with various types of brain injuries (traumatic, ischemic, and hemorrhagic). Historically, monitoring of intracranial pressure and cerebral perfusion pressure has been the mainstay of neuromonitoring techniques used at the critical care bedside to monitor brain perfusion and oxygenation. This article describes the bedside neuromonitoring techniques that have emerged for use with these patients in the critical care area. To give the reader an understanding of the functionality of these neuromonitoring techniques, the article first summarizes the physiology of brain perfusion and oxygenation.
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Crit Care Nurs Clin North Am · Sep 2014
ReviewThe physiologic role of erythrocytes in oxygen delivery and implications for blood storage.
Erythrocytes are not just oxygen delivery devices but play an active metabolic role in modulating microvascular blood flow. Hemoglobin and red blood cell morphology change as local oxygen levels fall, eliciting the release of adenosine triphosphate and nitric oxide to initiate local vasodilation. ⋯ This article reviews the functional anatomy and applied physiology of the erythrocyte and the microcirculation with an emphasis on how erythrocytes modulate microvascular function. The effects of cell storage on the metabolic functions of the erythrocyte are also briefly discussed.
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Crit Care Nurs Clin North Am · Jun 2014
ReviewNutrition in the pediatric population in the intensive care unit.
Nutrition is an essential component of patient management in the pediatric intensive care unit (PICU). Poor nutrition status accompanies many childhood chronic illnesses. A thorough assessment of the critically ill child is required to inform the plan for nutrition support. ⋯ To prevent inappropriate caloric intake, reassessment of the child's nutrition status is imperative. Enteral nutrition is the recommended route of intake. Human milk is preferred for infants.