American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Use of the interprofessional Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is recommended practice in intensive care, but its adoption remains limited. ⋯ Focusing interventions on workload burden and factors influencing bundle difficulty may facilitate ABCDE bundle adherence.
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Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. ⋯ Delirium occurs in at least 1 in 5 patients after transcatheter or surgical aortic valve replacement. Delirium is less likely to develop in the transcatheter group but is associated with higher mortality in both groups.
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Poor sleep and immobility are common in patients in the medical intensive care unit (MICU) and are associated with adverse outcomes. Interventions to promote sleep and mobilization in the MICU are gaining popularity, but feasible instruments to measure their effectiveness are lacking. Actigraphy may be useful for large-scale, continuous measurement of sleep and activity, but its feasibility in MICU patients has not been rigorously evaluated. ⋯ Uninterrupted actigraphy is feasible and generally well tolerated by MICU patients and may be considered for future large-scale studies. Wrist and ankle actigraphy measurements of sleep and activity in this setting agree poorly and cannot be used interchangeably.
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Cross-sectional studies suggest that patients treated with extracorporeal membrane oxygenation (ECMO) have adverse health outcomes and high risk for mental health problems after discharge. ⋯ Physical health was more severely impaired than was mental health, and both types improved over time. The EuroQol-5-Dimensions-5-Levels instrument was useful for detecting neurological problems of the lower extremities early and may qualify as a core outcome measure for patients treated with ECMO.
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Randomized Controlled Trial
Safety and Acceptability of Patient-Administered Sedatives During Mechanical Ventilation.
Safety and acceptability of sedative self-administration by patients receiving mechanical ventilation is unknown. ⋯ For select patients, self-administration of dexmedetomidine is safe and acceptable.