Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Feb 2013
Feasibility of a sedation wake-up trial and spontaneous breathing trial in critically ill trauma patients: a secondary analysis.
To determine the feasibility of conducting a sedation wake-up trial (SWT) plus a spontaneous breathing trial (SBT) in critically ill trauma patients based on the ability to implement the combined intervention; to measure and describe patients' physiological responses; and to maintain patient safety. ⋯ SWT plus SBT was well tolerated and successfully implemented. Our data showed that it is not necessary to withhold continuous-infusion analgesia during the SWT.
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Intensive Crit Care Nurs · Feb 2013
Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient.
Reliability of clinical scales and haemodynamic variables for assessing sedation depth in critically children is limited, particularly for those receiving neuromuscular blocking agents (NMBAs). ⋯ Post-intervention, BIS monitoring was adopted in PICU for children receiving NMBAs. One year later, this practice is sustained, and the percentage of BIS-monitored patients has increased. Guidelines addressing the use of BIS in patients not receiving paralytics are needed.
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Intensive Crit Care Nurs · Dec 2012
Review Case ReportsConfounding factors in brain death: cardiogenic ventilator autotriggering and implications for organ transplantation.
Brain death is characterised by a flaccid, areflexic neurological examination; fixed, dilated and midpoint pupils and total absence of intrinsic respiratory drive. A non-reversible clinical state or brain lesion must also be identified. Integral to brain death diagnosis is loss of respiratory drive. ⋯ In a patient with no apparent neurological function who is still triggering ventilator breaths, detailed analysis of ventilator pressure/flow waveforms in context with neurological assessment findings can identify cardiac autotriggering in a brain-dead patient. Undetected, cardiogenic ventilator autotriggering results in prolonged ICU stay and potential loss of transplantable organs. Collaborative practice and aggressive surveillance to determine loss of all neurologic function and evaluate possible autotriggering in this population is paramount and can minimise ICU stay, reduce costs of care, decrease family stress and facilitate recovery of transplantable organs.
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Intensive Crit Care Nurs · Dec 2012
Comparative StudyExamining the positive effects of exercise in intubated adults in ICU: a prospective repeated measures clinical study.
Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. ⋯ A growing body of evidence demonstrates that early, progressive exercise has significant benefits to intubated adults. These results should encourage clinicians to add mobility protocols to the care of ICU adults and lead to future studies to determine optimal "dosing" of exercise in ICU patients.
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Intensive Crit Care Nurs · Dec 2012
Multicenter StudyValidation of the Greek version of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
Delirium is associated with the most adverse outcomes in critically ill patients but it is often undiagnosed and untreated. The Confusion Assessment Method for Intensive Care Unit (CAM-ICU) is widely used for delirium assessment. This scale, however, has not been translated and validated into the Greek language. This paper is a report of the translation and validation of the CAM-ICU into Greek. ⋯ CAM-ICU seems to be a valid and reliable instrument for delirium detection in Greek intensive care patients, which can be easily incorporated in every day clinical practice after appropriate training.