American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study.
Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. ⋯ CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients.
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Critically ill patients who need mechanical ventilation require endotracheal suctioning. Guidelines recommend coarse crackles over the trachea and/or the presence of a sawtooth pattern on the flow-volume loop of the ventilator waveform as the best indicators. ⋯ Patients receiving mechanical ventilation should be routinely assessed for coarse crackles over the trachea, the most common indicator for endotracheal suctioning. Despite common practice, assessment of lung sounds to identify the need for suctioning is not supported.
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Maintaining oral hygiene is a key component of preventing ventilator-associated pneumonia; however, practices are inconsistent. ⋯ The content and dissemination method of institutional guidelines on oral hygiene do influence the oral hygiene practices of critical care nurses. Future studies examining how institutional guidelines could best be incorporated into routine workflow are needed.
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Historically, nursing productivity has been measured in adult settings and based on time, intensity, and resource allocation. ⋯ The CAMEO tool was comprehensive in describing and quantifying the cognitive workload of pediatric critical care nurses. The CAMEO classification process informs staffing needs that support synergy between the needs of patients and their families and nurses' knowledge and skill. Articulation of nursing care focused on informed clinical decision making is needed to justify the value of skilled nurses.