American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Few studies address predictors for successful weaning of older adults from mechanical ventilation. ⋯ Persistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.
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The predictive accuracy of scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) for in-hospital mortality among critically ill cancer patients varies. ⋯ APACHE II scores are predictive of hospital mortality in critically ill cancer patients. The presence of metastasis and respiratory failure at admission are also associated with outcome.
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To minimize the occurrence of adverse events among patients, critical care nurses must be alert to subtle changes in patients' conditions, perform accurate clinical assessments, and respond expediently. However, little is known about the effects of the nurses' work hours on vigilance and patients' safety. ⋯ The findings support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses' work hours to no more than 12 consecutive hours during a 24-hour period.
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Among survivors of prolonged mechanical ventilation, preferences for this treatment have rarely been explored. ⋯ Most patients would have chosen mechanical ventilation. Survivors' preferences were influenced by their current health and families' financial burden and stress.
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Neuromuscular blocking agents used for therapeutic purposes, such as facilitating mechanical ventilation and relieving life-threatening agitation, paralyze patients but leave them fully conscious. Aggressive sedation or analgesia is necessary to reduce awareness, relieve fear, produce comfort, decrease anxiety, induce unconsciousness, and minimize possible complications such as posttraumatic stress syndrome. Little information is available on the extent to which patients experience awareness during therapeutic paralysis. ⋯ Patients can remember having both negative and positive experiences during neuromuscular blockade. Steps to improve the experiences of patients receiving neuromuscular blockers include improving assessment parameters, developing and using sedation/analgesia guidelines, and investing in quality improvement programs to provide assessment of awareness during therapeutic paralysis and follow-up and referral as necessary. Ways to decrease the use of neuromuscular blockers would also be useful.