American journal of critical care : an official publication, American Association of Critical-Care Nurses
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In pediatric critical care, family-centered care is a central theme that ensures holistic care of the patient and the patient's family. Parents expect and are encouraged to be involved in the care of their child throughout all phases of the child's illness. Family presence is generally accepted when the child's condition is stable; however, there is less consensus about family presence when the child becomes critically ill and requires resuscitation and/or invasive procedures. ⋯ These studies support the suggestion that family presence during resuscitation and invasive procedures increases parents' satisfaction and coping. However, the generalizability of these findings is limited by small sample sizes and inconsistent evaluation of confounding variables. Further research is needed to determine the benefits of family presence and prevent barriers to true implementation.
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The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. ⋯ Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.
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A tracheostomy is often performed when patients cannot be weaned from mechanical ventilation. Respiratory infections (ventilator-associated pneumonia and infection of the lower respiratory tract) complicate the course of hospitalization in patients receiving mechanical ventilation. ⋯ Data related to respiratory infections that occurred before a tracheostomy were similar to data related to infections that occurred after a tracheostomy. Most infections were classified as lower respiratory infection rather than pneumonia. Infection, before or after a tracheostomy, resulted in longer stays and higher costs for care. Interventions focused on preventing infection before and after tracheostomy are warranted.
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End-stage liver disease (ESLD), the final stage of chronic liver disease, is treated with liver transplant. Many patients have serious ESLD-related complications and are admitted to the intensive care unit for treatment. Such patients are temporarily unsuitable to undergo transplant surgery and are placed into a temporarily inactive category, "status 7," on the transplant waiting list. ⋯ Family members' perspectives fit into 3 phases that correspond to the progression of the patient's clinical condition: dealing with crisis, confusion and frustration, and back on the road to transplant. All 3 phases related to 1 goal: getting the patient's status reactivated on the liver transplant waiting list. This case exposes the struggles that patients with ESLD and their families may go through during the status 7 period and could serve as a starting point for further examination of this period.
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Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. ⋯ Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.