Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Jun 2005
A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children.
The aim of this study was to identify the optimal rates at which opioids and benzodiazepines should be weaned in order to prevent withdrawal reactions in the pediatric intensive care unit (PICU). This study follows an earlier investigation that developed a graphical analysis method for examining behavioral signs of withdrawal in relation to changes in opioid and benzodiazepine administration. ⋯ Adverse withdrawal reactions were prevented when the daily rate of weaning did not exceed: 20% for children receiving continuous infusions for 1-3 days; 13-20% for 4-7 days; 8-13% for 8-14 days; 8% for 15-21 days; and 2-4% for more than 21 days of infusions. The authors recommend that the rate of weaning of opioids and benzodiazepines in critically ill children be tailored to the length of time the child received continuous infusions of these agents.
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Intensive Crit Care Nurs · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialA randomised controlled trial of weaning from mechanical ventilation in paediatric intensive care (PIC). Methodological and practical issues.
Most children admitted to the Paediatric Intensive Care Unit (PICU) require assistance with breathing via a mechanical ventilator. Weaning from mechanical ventilation is the transition from ventilatory support to spontaneous breathing. Traditionally weaning has been with the authority of the medical staff. However, current opinion suggests that weaning could be performed by nurses using a standardised protocol [Schultz TR, Lin RJ, Watzman HM, Durning SM, Hales R, Woodson A, et al. Weaning children from mechanical ventilation: A prospective randomised trial of protocol-directed versus physician-directed weaning. Respir Care 2001;46(8):772-82]. The potential advantages of nurse-led (protocol-directed) weaning include: A reduction in weaning time and PICU stay with cost savings. Reduced complications. Improved quality of care. Appropriate use of resources. ⋯ The trial was unsuccessful due to Recruitment issues. Physical constraints. Impractical entry criteria. Limited randomisation service. Ethical constraints. Barriers to parental participation. The methods, the difficulties encountered and the implications for future research are addressed.
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Intensive Crit Care Nurs · Apr 2005
Development of a new eye care guideline for critically ill patients.
Ventilated, critically ill patients have an increased risk of corneal exposure and microbial keratitis; however there is evidence that eye care is a neglected area of patient care. An audit of eye surface disease and eye care documentation revealed a problem within one general intensive care unit (GICU). An education programme was developed to highlight the incidence of eye surface disease and importance of eye care in the ventilated patient.
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Intensive Crit Care Nurs · Apr 2005
Finding the voice of clinical experience: participatory action research with registered nurses in developing a child critical care nursing curriculum.
The voice of clinical nurses is important to find and hear in the design of curricula. A participative action research project proposed to add this voice to the design of a new Critical Care Child Nursing programme at the University of Cape Town (UCT). Nurses' experiences of nursing critically ill children and their perceived learning needs in this context, were the central focus of the study. ⋯ Findings indicate that the Critical Care Child Nurse needs not only a specialised knowledge base and acutely developed assessment skills, but also astute interpersonal skills. The nurse's professional identity and integration into the multidisciplinary team need exploring. Together with the development of interpersonal skills, the nurse needs to engage the child and family.