American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The blood-conserving technology of continuous intra-arterial blood gas monitoring has recently been introduced into the field of critical care. This type of monitoring is a real-time method for concomitantly assessing oxygenation, ventilation, and acid-base status in pediatric and adult populations through an indwelling (in vivo) sensor residing in a peripheral artery. This article examines the technology underpinning in vivo blood gas monitoring and reviews research documenting clinical performance, as well as benefits and clinical applications of three-analyte systems in critically ill patients. ⋯ Although most clinical research in critically ill adults has revealed good clinical performance of in vivo blood gas sensors, reports of aberrant blood gas values and sensor problems remain; no reports have been published to date evaluating continuous intra-arterial blood gas monitoring in children or infants. Many benefits of this technology have been postulated, and research examining its effect on patient and cost outcomes in critically ill populations is pending. Clinicians in critical care must keep abreast of this emerging technology, because it holds significant potential for improving the quality of care and outcomes of critically ill patients.
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Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. ⋯ Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.
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Increasing emphasis will be placed on the efficient delivery of healthcare. This article concentrates on recommendations for cost containment including increased cost consciousness, elimination of waste, improved quality of care, and use of the team approach to cost containment. The resources over which bedside nurses and managers in critical care have direct or indirect control are the focus of this discussion.