American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study Comparative Study
Effects of systematic oral care in critically ill patients: a multicenter study.
No standard oral assessment tools are available for determining frequency of oral care in critical care patients, and the method of providing oral care is controversial. ⋯ Oral assessment scores improved after nurses implemented a protocol for systematic oral care. Use of the Beck Scale and the mucosal-plaque score could standardize oral assessment and guide nurses in providing oral interventions.
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Many critically ill patients are transferred to other care facilities instead of to home at hospital discharge. ⋯ The model, which did not include baseline function or social variables, provided good discrimination between patients discharged to a care facility after critical illness and patients discharged to home. These results suggest that future research should focus on the debilitating effects of respiratory failure and on conditions with cognitive and neuromuscular sequelae.
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Comparative Study
Measurement of end-tidal carbon dioxide in spontaneously breathing children after cardiac surgery.
Respiratory monitoring is important after surgery to prevent pulmonary complications. End-tidal carbon dioxide (Petco(2)) measurement by capnometry is an indirect and noninvasive measurement of Pco(2) in blood and is accepted and recognized in critical care. ⋯ In spontaneously breathing children, Vt-Petco(2) provided a more accurate estimate of Paco(2) than did VC-Petco(2), especially in children given little or no supplemental oxygen. The difference between the methods was significantly larger in the groups given 2 to 5 L of oxygen per minute.
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Intensive insulin treatment is associated with an increased risk of hypoglycemia, so strict glycemic monitoring is essential. The best type of sample for identifying hypoglycemia remains under debate. ⋯ With a target blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected in critically ill patients, regardless of whether insulin is administered intravenously or subcutaneously. Analysis of solely arterial samples may yield a higher prevalence of hypoglycemia than otherwise.