American journal of critical care : an official publication, American Association of Critical-Care Nurses
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To determine the effect of a monitored care unit on resource utilization in a pediatric ICU. ⋯ Use of beds in the pediatric ICU was more efficient when a high-observation setting was available for low-risk monitored patients. Key differences in patterns of use were observed. Compared with the pediatric ICU, the monitored care unit requires fewer personnel and less expensive equipment and supplies, but it still allows potentially life-threatening complications to be recognized and treated. For patients who meet its admission criteria, the monitored care unit is a safe alternative to the pediatric ICU.
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Although dedicated monitor watchers are used in many progressive care units with telemetry monitors, this costly practice has not been evaluated. ⋯ The efficiency and quality of patient care can be enhanced by using a dedicated monitor watcher. The results of this study raise the question of whether improved accuracy of detection of dysrhythmias results in better outcomes for patients.
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Previous research has emphasized the importance of visitation in critical care units and its beneficial effects on patients and their families. However, nurses' attitudes and beliefs about visitation did not correlate with those of patients and their families, nor did actual visitation practices correlate with written policy. ⋯ Data indicate that most nurses do not restrict visitation, regardless of whether restrictive policies are in place. Most nurses base their visitation decisions on the needs of the patient and the nurse. Needs of the family were ranked as less important in decision making about family visitation.
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This review focuses on how patients' recall of their stay in the ICU can be modified pharmacologically. ⋯ Patients may remember their stay in the ICU, depending on the type of injury and the drug therapy. Of the drugs presented, benzodiazepines most reliably provide anterograde amnesia, whereas ketamine and propofol exhibit dose-dependent effects on memory.
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Critically ill patients are susceptible to injury of the intestinal mucosa, changes in gut permeability, and failure of intestinal defense mechanisms. These conditions put the patients at risk for infection and multiple organ dysfunction syndrome. Specific therapies are needed to prevent gut failure during critical illness. ⋯ Further research should focus on specific strategies to enhance gut function, prevent loss of gut integrity, and improve patients' outcomes. These strategies include maintaining mesenteric blood flow, using gastric tonometry to assess oxygenation, inhibiting inflammatory mediators, and using growth factors to modify the metabolic state in patients who are critically ill.