American journal of critical care : an official publication, American Association of Critical-Care Nurses
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To compare physicians' estimates of cardiac index and intravascular volume with transesophageal Doppler measurements obtained by critical care nurses, to assess the overall safety of transesophageal Doppler imaging by critical care nurses, and to compare hemodynamic measurements obtained via transesophageal Doppler imaging with those obtained via pulmonary artery catheterization. ⋯ Physicians' assessment of cardiac index and intravascular volume in patients receiving mechanical ventilation is correct less than half of the time. Transesophageal Doppler imaging by critical care nurses appears to be a safe method for measuring cardiac index and estimating intravascular volume. Measurements obtained via Doppler imaging correlate well with those obtained via pulmonary artery catheterization.
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Comment Comparative Study
Risk of colonization of central venous catheters: catheters for total parenteral nutrition vs other catheters.
Infected central venous catheters cause morbidity and mortality. ⋯ Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients' care.
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Comparative Study
Administration of sedatives and level of sedation: comparative evaluation via the Sedation-Agitation Scale and the Bispectral Index.
To compare levels of sedation in patients receiving continuous intravenous infusions of sedative/hypnotic or narcotic agents with levels in patients not receiving infusions and to compare subjective (Sedation-Agitation Scale) and objective (Bispectral Index) evaluations of sedation. ⋯ Objective and subjective assessments of sedation are highly correlated. Use of continuous infusions is associated with deeper levels of sedation, and patients receiving continuous infusions are more likely to be oversedated. Sedation therapy should be guided by subjective or objective assessment.
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Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization. ⋯ Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.
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Assessment and management of patients' pain across practice settings have recently received the increased attention of providers, patients, patients' families, and regulatory agencies. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have aided in the improvement of pain management practices. ⋯ The state of nursing science of pain in critically ill patients, including development and testing of pain assessment methods and clinical trials of pharmacological interventions, is described. Special emphasis is placed on results from the Thunder Project II, a major multisite investigation of procedural pain.