American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Cardiac dysfunction is one of many causes for unsuccessful weaning from mechanical ventilation. Although cardiac dysfunction can be detected via direct measurement of cardiac output during weaning, available methods are not feasible. ⋯ A noninvasive method of monitoring cardiac output can be easily applied while patients are being weaned off of mechanical ventilation.
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Patients in intensive care units are likely to have limited mobility owing to hemodynamic instability and activity orders for bed rest. Bed rest is indicated because of the severity of the disease process, which often involves intubation, sedation, paralysis, surgical procedures, poor nutrition, low flow states, and poor circulation. These patients are predisposed to the development and/or the progression of pressure ulcers not only because of their underlying diseases, but also because of limited mobility and deconditioned states of health. ⋯ A prophylactic sacral dressing may help prevent unit-acquired sacral pressure ulcers. Implementation of an involved care team with heightened awareness and increased education along with a prophylactic sacral dressing in patients deemed high risk for skin breakdown are all essential for success.
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Observational Study
Stimulation of Critically Ill Patients: Relationship to Sedation.
To describe the number and type of stimulation events and the relationship of stimulation to sedation level in patients receiving mechanical ventilation. ⋯ Critically ill patients receiving mechanical ventilation are subjected to various forms of auditory and tactile stimulation frequently throughout the day. All types of stimuli increased arousal in patients who were more deeply sedated. The effect of stimulation in patients who were not deeply sedated was minimal and inconsistent.
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Although many patients with chronic obstructive pulmonary disease (COPD) require a prolonged length of stay (PLOS) following coronary artery bypass grafting (CABG), the impact of PLOS on long-term survival has not been examined in this population. ⋯ COPD and PLOS are 2 of many factors that affect long-term mortality in postoperative CABG patients. Aggressive treatment strategies aimed at early weaning off of mechanical ventilation and prevention of reintubation among COPD patients must be considered carefully as a means to reduce length of stay after CABG. Our results also have important implications for the long-term management of these patients and strategies for containing costs over the life course of the patient.