American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of position on selected hemodynamic parameters in postoperative cardiac surgery patients.
Indirect/noninvasive blood pressure, heart rate and central venous pressure are frequently monitored hemodynamic parameters in postoperative cardiac surgery patients. No previous studies have explored the effect of lateral position on these variables in this population. ⋯ Lateral positioning of postoperative cardiac surgery patients appears to cause no detrimental effects on indirect/noninvasive blood pressure or heart rate measurements. However, significant differences in central venous pressure may occur and supine positioning for determination of central venous pressure is recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of two dosing regimens of intravenous ranitidine on gastric pH in critically ill children.
Gastric bleeding in children is associated with critical illness, shock, and physical trauma. Histamine-2 receptor antagonist therapy is used prophylactically to treat gastric bleeding, but it is not known whether bolus dosing or continuous infusion dosing is more effective. ⋯ Both bolus dosing and continuous infusion dosing of 4 mg/kg per day of intravenous ranitidine were effective at raising and maintaining gastric pH in critically ill children.
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Clinical Trial
Differences in end-tidal carbon dioxide and breathing patterns in ventilator-dependent patients using pressure support ventilation.
Although several investigators have assessed the effects of pressure support ventilation on tidal volume and breathing patterns, none have investigated the combination of breathing patterns and end-tidal carbon dioxide in ventilator-dependent patients. ⋯ Pressure support ventilation prevents asynchronous chest and abdominal movement and lowers the level of end-tidal carbon dioxide. Pressure support ventilation offers clinicians a way to lower the elevated carbon dioxide level that often occurs in critically ill patients. Increasing tidal volume and reducing the work of breathing by using pressure support ventilation may reduce diaphragm fatigue in ventilator-dependent patients.
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Clinical Trial
Ulnar peripheral nerve stimulation by train-of-four technique in adult nonmedicated patients.
Peripheral nerve stimulation is necessary to quantify the level of neuromuscular blockade and prevent prolonged paralysis related to drug accumulation. Some nurses and physicians are hesitant to administer nerve stimulation because of concerns about inflicting pain on the patient. ⋯ Nerve stimulation by train-of-four method was moderately uncomfortable but not painful. Heart rate response could not be relied on as a measurement of discomfort. Protocols for stimulation should include testing at level 4 and increasing as necessary to cause thumb adduction.