American journal of critical care : an official publication, American Association of Critical-Care Nurses
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A 30° head-of-bed elevation is recommended for most critically ill patients. Measuring intrabladder pressure with the patient in this position is controversial. ⋯ It is feasible to measure intrabladder pressure with a 30° head-of-bed elevation, and that position could be an alternative to supine positioning of patients for measurement of intrabladder pressure.
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Intra-aortic balloon counterpulsation is the most widely used therapy for support of a compromised left ventricle. The principles of counterpulsation were developed in the 1950s, and intra-aortic balloon pumps have been used for more than 40 years. Despite this long-standing clinical use, many of the timing practices have continued almost unchanged from their inception. ⋯ The principles of timing are based on the physiological objectives of counterpulsation; however, research into alternative timing methods has led to conflicting and often confusing information on the appropriate timing method for a specific clinical situation or patient. Although a body of knowledge is available, much of the research is dated and covers only specific timing methods or populations of patients. Further evidence is needed to support the selection of timing methods and determine the clinical benefits of the various methods.
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Technology permeates every dimension of critical care. Bedside technology is integral to the assessment and monitoring of patients and to the provision of treatment. It also helps with access to vital information and can enhance communication. ⋯ The human-machine interface, or how clinicians and patients interact with health care technology, is a crucial focus of research. Technology is at the heart of critical care. It allows clinicians to perform miracles, but is also a seductive and self-perpetuating force that needs careful monitoring by those who use it.
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Randomized Controlled Trial
Daily interruption of sedation in patients receiving mechanical ventilation.
Daily interruption of continuous infusion of sedatives has improved outcomes in patients receiving mechanical ventilation in open-label studies. ⋯ The double-blinded design for assessment of sedation interruption in patients receiving mechanical ventilation was safe and effective. Slow recruitment of patients and frequent noncompliance with the protocol suggest that modifications to the protocol are needed.