American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Meta Analysis
Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis.
In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. ⋯ Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.
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Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients. ⋯ Among weaning trial echocardiographic parameters, LVEF was the only independent predictor of successful VA-ECMO weaning. An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning and was related to final survival.
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In 2019, an interprofessional team at Texas Children's Hospital designed and instituted developmental care rounds to better coordinate developmentally appropriate care within the cardiac intensive care unit. During the first 2 years, we conducted 230 developmental care rounds on 169 patients; for these rounds, family participation was greater than 85%. ⋯ Importantly, the structure of these rounds has evolved to prominently integrate family members' perspectives and experiences. Lessons learned through developmental care rounds have formed a foundation for implementing other developmentally appropriate practices and initiatives throughout the hospital's Heart Center.
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Tracheostomies are highly aerosolizing procedures yet are often indicated in patients with COVID-19 who require prolonged intubation. Robust investigations of the safety of tracheostomy protocols and provider adherence and evaluations are limited. ⋯ Multidisciplinary engagement in the development and implementation of a COVID-19 tracheostomy protocol is associated with acceptable safety for all members of the care team.