American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Room-temperature thermodilution cardiac output: proximal injectate lumen vs proximal infusion lumen.
To assess the accuracy of room-temperature thermodilution cardiac output measurements from the venous infusion port. ⋯ Room-temperature thermodilution cardiac output determinations from the venous infusion port can be used in place of central venous port cardiac outputs if the central venous port becomes nonfunctional.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of patient-controlled analgesia on postoperative anxiety in elderly men.
To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety. ⋯ The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.
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A preliminary investigation of opinions and behaviors regarding advance directives for medical care.
Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. ⋯ Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.
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Comparative Study
Pilot study: validating staff nurses' observations of sleep and wake states among critically ill patients, using polysomnography.
Effective management of sleep pattern disturbance begins with accurate assessment of the patient's sleep and wake states. ⋯ There is some basis for using staff nurses as observers of sleep and wake states. Increased credence can be placed on nursing assessments and diagnosis of sleep pattern disturbance, resulting in more timely and effective management of the problem.
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Infection is the primary cause of morbidity and mortality following cardiac transplantation because of the strict immunosuppressive regimens patients follow. In the immediate postoperative phase, patients are more susceptible to infection because of interruption of their external barriers to infection. ⋯ Fungal, protozoal and herpes simplex infections are also frequently troublesome to the transplant recipient. Critical care clinicians can control the incidence of infection in the cardiac transplant population by initiating measures to maintain external barriers, monitoring the patient for early signs of infection, and instituting appropriate isolation techniques.