American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates' consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.
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Perioperative outcome data related to metabolic syndrome in coronary artery bypass graft (CABG) patients are lacking. ⋯ Both female patients and patients with metabolic syndrome undergoing CABG surgery are at higher risk for longer postoperative stays. Women with metabolic syndrome are the CABG patients at highest risk for in-hospital death.
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Randomized Controlled Trial Multicenter Study
Clinical predictors of duration of action of cisatracurium and rocuronium administered long-term.
The duration of action of neuromuscular blocking drugs (NBDs) varies between individuals and even within individuals in different settings. ⋯ Duration of NBD treatment is strongly predictive of the duration of action of rocuronium, and body temperature is predictive of the duration of action of cisatracurium. These data may help decrease the incidence of drug-induced muscle weakness in recovery rooms and surgical intensive care units, particularly if neuromuscular transmission monitoring is not available.
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Randomized Controlled Trial
Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults.
Ventilator-associated pneumonia is associated with increased morbidity and mortality. ⋯ Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.
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Although enrolling a sufficient number of participants is a challenge for any multisite clinical trial, recruiting patients who are critically ill and receiving mechanical ventilatory support presents additional challenges because of the severity of the patients' illness and the impediments to their communication. Recruitment challenges related to the research sites, nursing staff, and research participants faced in the first 2 years of a 4-year multisite clinical trial of a patient-directed music intervention for managing anxiety in the intensive care unit were determined. Strategies to overcome these challenges, and thereby increase enrollment, were devised. ⋯ Other strategies, such as obtaining a waiver for a participant's signature, were instituted across all participating sites. Through implementation of these various strategies, the mean monthly enrollment of participants increased by 50%. Investigators are advised to plan well in advance of starting recruitment for a clinical trial based in an intensive care unit, anticipate peaks and valleys in recruitment, and be proactive in addressing issues creatively as the issues arise.