Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Apr 2003
Editorial ReviewSevere sepsis--a major challenge for critical care.
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Intensive Crit Care Nurs · Apr 2003
Multicenter StudyPredictors of backrest elevation in critical care.
Low backrest and supine positions are associated with increased mortality and ventilator associated pneumonia (VAP). Data are not available across ICU settings about the level of backrest position used and its relationship to enteral feeding and hemodynamic status. The purpose of this descriptive study was to document the level of backrest elevation and position and identify factors associated with and predict positioning in a medical, surgical and neuroscience intensive care unit. ⋯ Differences in backrest elevation for intubated versus nonintubated patients approached significance (P=0.07) with intubated patients at lower backrest elevations. In summary, use of higher backrest elevations (>30 degrees ) is minimal, is not related to feeding and minimally related to hemodynamic status. Strategies to meet published recommendations for backrest elevation (30-45 degrees ) must include repeated feedback about nurse's use of backrest elevation and estimates of elevation.
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Intensive Crit Care Nurs · Dec 2002
Developing a pain assessment tool for use by nurses in an adult intensive care unit.
Critically ill patients are particularly vulnerable to pain, patient's citing it as their second greatest ICU stressor. Pain has also been identified as a complicating factor in critical illness. Despite this, pain management is often not considered a priority by the ICU team. ⋯ As an aid to pain assessment and management a flow chart and a clinical guideline have also been introduced. Although preliminary evaluation established the effectiveness of the tool as a means of estimating and recording pain levels in individual patients, it was evident that there has been no change to the way in which pain is managed. To address this issue, the level of nurses understanding regarding pain management has been ascertained and teaching sessions delivered to increase the profile of pain management in the unit.
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Non-invasive ventilation has been shown to be an effective treatment for acute hypercapnic respiratory failure. It is now increasingly used in the treatment of acute hypoxemic respiratory failure. National guidelines published by the British Thoracic Society state that facilities for NIV should be available 24 hours per day in all hospitals likely to admit such patients. ⋯ Conversely, results of a survey performed by the indicate that at the time of data collection, only 48% of United Kingdom hospitals provided an acute NIV service. The BiPAP Vision (Respironics Inc.) offers Continuous Positive Airway Pressure (CPAP), Bi-level Spontaneous/Timed and Proportional Assist Ventilation/Timed modes and is ideal for use in a critical care environment. This article presents some of the issues surrounding NIV, the impact of a new service, and the process of implementing NIV within a critical care setting.
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Remifentanil is a synthetic opioid receptor agonist that was introduced in 1997 for analgesia during general anaesthesia. However, it recently received a license for analgesia and sedation in ventilated intensive care patients and so is now of interest to those working in intensive care.