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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Multicenter Study Observational Study
Effects of Nursing Interventions on Intracranial Pressure.
Intracranial pressure is a frequent target for goal-directed therapy to prevent secondary brain injury. In critical care settings, nurses deliver many interventions to patients having intracranial pressure monitored, yet few data documenting the immediate effect of these interventions on intracranial pressure are available. ⋯ Response of intracranial pressure to nursing interventions is inconsistent. Most interventions were associated with inconsistent changes in intracranial pressure at 1 or 5 minutes after the intervention.
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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.
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Observational Study
Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit.
Anecdotal observation suggests that older patients in medical intensive care units receive higher doses of psychoactive medications during evening shifts than day and night shifts. ⋯ In this longitudinal, observational sample of older patients, data indicated a positive association between dose levels of lorazepam and haloperidol during the evening nursing shifts relative to other shifts. Further investigation is needed to determine potential causes and to evaluate the impact on outcomes of sleep deprivation and delirium.
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A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. ⋯ An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.