American journal of critical care : an official publication, American Association of Critical-Care Nurses
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In August 2008, the American Association of Critical-Care Nurses' (AACN's) Evidence-Based Practice Resource Work Group met to review current AACN Practice Alerts and to identify new Practice Alerts to be created. The work group was also tasked with reassessment of the grading system used by AACN that evaluates evidence associated with the Practice Alerts and other AACN resources. This article details the effort of this national volunteer work group, specifically highlighting the development of the new AACN evidence-leveling hierarchy system.
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Randomized Controlled Trial
Effect of mechanical chest percussion on intracranial pressure: a pilot study.
Treatment of brain injury is often focused on minimizing intracranial pressure, which, when elevated, can lead to secondary brain injury. Chest percussion is a common practice used to treat and prevent pneumonia. Conflicting and limited anecdotal evidence indicates that physical stimulation increases intracranial pressure and should be avoided in patients at risk of intracranial hypertension. ⋯ Mechanical chest percussion may be a safe intervention for nurses to use on neurologically injured patients who are at risk for intracranial hypertension.
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Randomized Controlled Trial
Oral care interventions and oropharyngeal colonization in children receiving mechanical ventilation.
Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. ⋯ Use of chlorhexidine combined with nonpharmacological oral care did not decrease the colonization profile, duration of mechanical ventilation, or length of stay in critically ill children receiving mechanical ventilation.
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As many as half of critically ill patients require mechanical ventilation. In this article, a program of research focused on reduction of risk associated with mechanical ventilation is reviewed. Airway management practices can have profound effects on outcomes in these patients. ⋯ The overall goals of sedation are to provide physiological stability, to maintain ventilator synchrony, and to ensure patients' comfort-although methods to evaluate achievement of these goals are limited. Reducing risks associated with mechanical ventilation in critically ill patients is a complex and interdisciplinary process. Our understanding of the risks associated with mechanical ventilation is constantly changing, but care of these patients must be based on the best evidence.