American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study Clinical Trial Controlled Clinical Trial
Agreement and clinical utility of 2 techniques for measuring cardiac output in patients with low cardiac output.
The reliability of cardiac output obtained with the bolus technique is a problem. ⋯ Measurements of cardiac output determined with the continuous technique may be more precise than measurements determined with the bolus technique. Continuous cardiac output information increases the number of treatment decisions and actions that may shorten hospital length of stay.
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Fever is a common phenomenon in critically ill patients. Ideally, all decisions about treatment of fever would be based on results of well-developed research studies. ⋯ This article is an evaluation of the usefulness of the research studies related to treatment of fever in the critically ill. Two questions are addressed: when is treatment of fever most beneficial to a critically ill patient, and how is fever most effectively treated in the critically ill? Evidence related to the treatment of fever is evaluated by using the recommendation levels of the research-based practice protocols of the American Association of Critical-Care Nurses.
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Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia. ⋯ Use of higher levels of backrest elevation (> or = 30 degrees) is minimal and is not related to use of enteral feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.
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Neuromuscular blocking agents are used in critically ill patients to induce therapeutic paralysis. These drugs leave patients fully immobile but conscious. Analgesics and sedatives are concomitantly administered with the paralytic agents. Little is known about what patients remember when they receive these combinations of drugs. Even less is known about the experiences and needs of the patients' family members during the patients' paralysis. ⋯ Two confounding variables may have affected these findings: a liberalized visiting policy and use of effective pain and sedation protocols. Healthcare professionals and patients' family members should monitor bedside conversations and use touch and words of encouragement to support patients during therapeutic paralysis.
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Use of propofol has recently gained popularity in intensive care settings for patients receiving mechanical ventilation. This newer intravenous sedative is often preferred over other sedatives because of a rapid onset of action, easy titration that allows neurological assessment during administration, and quick arousability of patients after the drug is discontinued. ⋯ The awakening time of patients receiving propofol for a protracted period, usually in conjunction with other potentiating drugs, may be longer than is commonly cited in the literature.