American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
Electrocardiographic Correlates of Acute Allograft Rejection Among Heart Transplant Recipients.
Acute allograft rejection appears to be associated with increases in QT/QTc intervals. ⋯ Moderate to severe acute allograft rejection was associated with electrocardiographic changes after transplant surgery. Studies are needed to assess the value of computerized electrocardiogram measurement algorithms for detecting acute allograft rejection.
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Multicenter Study
Validation of a Postextubation Dysphagia Screening Tool for Patients After Prolonged Endotracheal Intubation.
Patients who receive prolonged endotracheal intubation (> 48 hours) are at risk for dysphagia. Nurses should conduct swallowing assessments after extubation because of the high likelihood of aspiration pneumonia developing. No valid and reliable postextubation dysphagia screening tools are available. ⋯ The reliability and validity of a postextubation dysphagia screening tool that can help nurses determine an extubated patient's ability to swallow after prolonged endotracheal intubation were established.
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Clinical practice guidelines recommend enteral nutrition for most patients receiving mechanical ventilation. However, recently published evidence on the effect of enteral nutrition on mortality, particularly for patients who are well nourished, is conflicting. ⋯ The finding of a positive association between an order for enteral feeding and survival supports enteral feeding of patients in medical intensive care units. Furthermore, the beneficial effect of enteral feeding appears to apply to patients regardless of body mass index.
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Although higher backrest elevation may be a theoretical risk for integrity of sacral tissues, few data support use of high backrest elevation. ⋯ Level of backrest elevation is not associated with changes in tissue integrity. Body positioning in critically ill patients receiving mechanical ventilation may not be as important or as effective as once thought.
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Delirium occurs frequently in the intensive care unit and is associated with detrimental consequences. Cognitive training is a promising, nonpharmacologic, preventive intervention, but it is unknown whether cognitive training is feasible for patients in intensive care units. ⋯ Cognitive training exercises used in this study were feasible for intensive care unit patients (including cooperative patients with delirium) and their nurses. More research is needed to determine the clinical effect of the exercises on delirium outcome.