American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
Medical end-of-life decisions: experiences and attitudes of Belgian pediatric intensive care nurses.
To investigate Belgian pediatric intensive care nurses' involvement in and attitudes toward medical end-of-life decisions with a possible or certain life-shortening effect. ⋯ Belgian pediatric intensive care nurses are often involved in carrying out medical end-of-life decisions, including administration of life-ending drugs, whereas their participation in decision making is more limited. Most think that the current euthanasia law should be extended to minors so that administering life-ending drugs would be possible for terminally ill children in specific circumstances.
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Endotracheal tube cuff pressure must be maintained within a narrow therapeutic range to prevent complications. Cuff pressure is measured and adjusted intermittently. ⋯ Continuous monitoring of cuff pressure is feasible, accurate, and safe. Cuff pressures vary widely among patients.
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Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival. ⋯ Blood transfusion was associated with a decreased risk of late (>180 days) death in intensive care patients.
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High-frequency oscillatory ventilation is an alternative ventilation mode that improves oxygenation in trauma patients in whom conventional ventilation strategies have been unsuccessful. ⋯ Although high-frequency oscillatory ventilation improves oxygenation, severity of traumatic injury and organ failure, not respiratory parameters, are predictors of survival. High-frequency oscillatory ventilation should be considered for pulmonary rescue of severely injured patients with acute respiratory distress syndrome.
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Critically ill patients often require sedation and analgesia. Scales have been developed to provide clinicians with sedation targets. Daily interruption of continuous infusions of sedatives and sedation protocols improve patients' outcomes. However, perceived instability of a patient's condition can prevent implementation of appropriate sedation targets and daily interruption of sedation. ⋯ The severity-of-illness score had good interrater variability as a tool for determining sedation targets and identifying candidates for daily interruption of sedation. Future study on how use of the score affects sedative dosing and outcomes is needed.