American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial
Head-of-Bed Elevation and Early Outcomes of Gastric Reflux, Aspiration and Pressure Ulcers: A Feasibility Study.
Guidelines recommending head of bed (HOB) elevation greater than 30º to prevent ventilator-associated pneumonia conflict with guidelines to prevent pressure ulcers, which recommend HOB elevation less than 30º. ⋯ HOB elevation greater than 30º is feasible and preferred to 30º for reducing oral secretion volume, reflux, and aspiration without pressure ulcer development in gastric-fed patients receiving mechanical ventilation. More deeply sedated patients may benefit from higher HOB elevations.
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Multicenter Study
Physical recovery in intensive care unit survivors: a cohort analysis.
Some survivors of critical illness experience poor physical recovery, but which patients experience the most compromise during recovery is unknown. ⋯ Multiple factors are associated with physical recovery after critical illness. Interventions to target multidimensional aspects of recovery such as sleep and exercise may result in improved physical function after critical illness.
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Methicillin-resistant Staphylococcus aureus is a cause of lower respiratory tract infections, particularly health care- and ventilator-associated pneumonia. Although many health systems use nasal screening for this microorganism for infection control, correlation between nasal carriage of the organism and development of infections due to it is not clear. ⋯ Nasal screening for methicillin-resistant S aureus may be a valuable tool for de-escalation of empiric therapy targeted to the organism, especially in patients admitted for severe community-acquired or health care-associated pneumonia. The high negative predictive value suggests that patients with a negative nasal swab most likely do not have a lower respiratory tract infection caused by the organism.