American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Review Case Reports
The Evolving Paradigm of Individualized Postresuscitation Care After Cardiac Arrest.
The postresuscitation period after a cardiac arrest is characterized by a wide range of physiological derangements. Variations between patients include preexisting medical problems, the underlying cause of the cardiac arrest, presence or absence of hemodynamic and circulatory instability, severity of the ischemia-reperfusion injury, and resuscitation-related injuries such as pulmonary aspiration and rib or sternal fractures. Although protocols can be applied to many elements of postresuscitation care, the widely disparate clinical condition of cardiac arrest survivors requires an individualized approach that stratifies patients according to their clinical profile and targets specific treatments to patients most likely to benefit. This article describes such an individualized approach, provides a practical framework for evaluation and triage at the bedside, and reviews concerns specific to all members of the interprofessional postresuscitation care team.
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Observational Study
Prognostic Importance of Sleep Quality in Patients With Heart Failure.
Poor sleep quality is common and is associated with poor quality of life and health status in patients with heart failure. However, few investigators have focused on the impact of impaired sleep quality on survival in heart failure. ⋯ Impaired sleep quality was prevalent in patients with heart failure and was associated with poor cardiac event-free survival. Clinicians should assess and manage sleep quality in patients with heart failure to improve outcomes.
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Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. ⋯ The majority of intensive care patients most likely are not being screened for posttraumatic stress syndrome despite a higher risk for the syndrome in these patients than in the general population.