Critical care nursing clinics of North America
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The GI tract is an important line of defense in the body's immunologic system. Without the proper care and treatment, this defense fails, rapidly increasing critically ill patients' susceptibility to added infections and system failures. ⋯ As more research is completed, the role of the GI tract in critical illness and measures to maintain its integrity will be identified. In the meantime, the initiation of enteral nutrition is an important initiative.
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Crit Care Nurs Clin North Am · Jun 1999
Outcomes improvement following minimally invasive direct coronary artery bypass surgery.
The most progressive movement in the standardization of MIDCAB has occurred within the past 5 years. Standardization of care and continuous quality improvement are essential to improve outcomes and reduce costs for MIDCAB. At the authors' institution, perioperative clinical outcomes demonstrated no significant differences among a traditional single-vessel CABG and a MIDCAB in myocardial infarction rates, reoperations for bleeding, and cerebrovascular accidents. ⋯ The reported clinical outcomes are appropriate variables to track for continuous quality improvement. These clinical outcomes are meaningful, measurable, and appropriate for evaluating the effectiveness of care but do not address quality of life, patient satisfaction, and efficacy of pain management. Nursing care must continue to evolve as more data become available.
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This article has reviewed some of the current airway management practices as well as technologic advances in adult tracheal tube design in the critically ill patient. Although the primary goals of airway protection and facilitation of positive pressure ventilation remain unchanged, a better understanding of the limitations of tracheal tubes, as well as strategies for optimized airway management, is critical. Such information is needed in order to reduce or avoid potential complications associated with tracheal tubes or similar airway devices.
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsContinuous mixed venous (SvO2) monitoring. Too expensive or indispensible?
Based on theoretic principles and clear literature support, SvO2 (mixed venous oxyhemoglobin) monitoring offers an important advantage over traditional hemodynamic parameters. SvO2 allows more precise understanding of the adequacy of cardiac and pulmonary function than traditional parameters. SvO2 values do not replace the need to measure individual parameters of oxygen delivery or consumption but serves as the standard for assessing the impact of each parameter on tissue oxygenation. ⋯ The cost-effectiveness of the catheter, like any technology, is predicated on the clinician. Clinicians++ must be educated to use SvO2 as a primary end point for treatment decisions regarding hemodynamic therapy and patient stability. If used properly, every PAC should use fiberoptic SvO2 capabilities.
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Crit Care Nurs Clin North Am · Mar 1999
Review Case ReportsCapnography. A key underutilized technology.
Based on the multiple applications and the potential cost savings, every ICU should have enough capnography for all intubations and probably for all mechanically ventilated patients. Of the multiple clinical applications of capnography, most attention should be focused on its use with intubation and resuscitation. Other applications, such as blood gas and ventilation-perfusion scan reduction, should be instituted after the primary areas have been implemented. While capnography modules may appear to be expensive at first glance, an analysis of their clinical application reveals they can save the hospital hundreds of thousands of dollars beyond the purchase price.