American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
An efficiency evaluation of protocols for tight glycemic control in intensive care units.
The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. ⋯ Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.
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Cessation of circulation during cardiac arrest causes critical end-organ ischemia. Although the neurological consequences of cardiopulmonary arrest can be catastrophic, an aggressive "push fast and push hard" resuscitation technique maintains blood flow until the return of spontaneous circulation. However, reperfusion to the cerebrum leads to cellular chaos and further neurological injury. ⋯ A 43-year-old man had 2 asystolic arrests with 20 minutes of cardiopulmonary resuscitation as a result of massive, multiple pulmonary emboli. After the cardiac arrest, the patient was comatose and posturing. The 2005 American Heart Association guidelines for cardiopulmonary resuscitation were used along with moderate hypothermia in an attempt to minimize the neurological consequences of the cardiopulmonary arrest and to optimize the patient's outcome.
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Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia in intensive care units. Although considered basic and potentially nonessential nursing care, oral hygiene has been proposed as a key intervention for reducing ventilator-associated pneumonia. Nevertheless, evidence from randomized controlled trials that could inform best practice is limited. ⋯ Despite the importance of providing oral hygiene to intensive care patients receiving mechanical ventilation, high-level evidence from rigorous randomized controlled trials or high-quality systematic reviews that could inform clinical practice is scarce.
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Nurses are often responsible for placement of large-bore gastric tubes. Tube misplacement into the lungs is a potential complication with serious sequelae. The reliability of common bedside methods for differentiating between pulmonary and gastric placement has not been acceptable. ⋯ Neither air insufflation nor capnometry is a fail-safe method for determining placement of gastric tubes. Radiography remains the preferred method.
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Randomized Controlled Trial
Animal-assisted therapy in patients hospitalized with heart failure.
Animal-assisted therapy improves physiological and psychosocial variables in healthy and hypertensive patients. ⋯ Animal-assisted therapy improves cardiopulmonary pressures, neurohormone levels, and anxiety in patients hospitalized with heart failure.