American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Suitability of Capillary Blood Glucose Analysis in Patients Receiving Vasopressors.
Glycemic control in critically ill patients decreases infection and mortality. Patients receiving vasopressors have altered peripheral perfusion, which may affect accuracy of capillary blood glucose values measured with point-of-care devices. ⋯ Even when the more accurate POCT with arterial blood is used, blood glucose values are significantly less accurate in patients receiving more than 2 vasopressors than in patients receiving fewer vasopressors. CCLT may be safer for titrating insulin doses in these patients.
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Because reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, it is reasonable to hypothesize that the detection of pepsin (the major gastric enzyme in gastric juice) in oral secretions may provide a relatively noninvasive method of predicting risk for aspiration. ⋯ Although reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, individual reflux events do not necessarily lead to aspiration. Thus, it is reasonable that we found pepsin 5 times more often in oral secretions than in tracheal secretions.
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Facial expression is often used to evaluate pain in noncommunicative critically ill patients. ⋯ Upper facial expressions are most frequently activated during pain response in noncommunicative critically ill patients and might be a valid alternative to self-report ratings.