American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Multicenter Study Clinical Trial
Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination.
Evaluating the independent effects of psychosocial and physiological factors on survival of cardiac patients is difficult because it requires obtaining extensive physiological and psychosocial data and long-term follow-up of high-risk patients. ⋯ Among patients who had asymptomatic ventricular arrhythmias after myocardial infarction, psychological status during the period after infarction contributed to mortality beyond the effect of physiological status. The results reaffirm the critical interrelationship between mind and body for cardiovascular health.
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Long-term ICU patients who require prolonged mechanical ventilation are a growing segment of the in-hospital population. Despite recognition that this population is costly to care for no systematic research has been done on the characteristics, outcomes, and disposition of these patients after they leave the hospital. ⋯ A large percentage of ICU patients who require 5 days or more of mechanical ventilation die in the hospital, and many of those who live spend considerable time in an extended-care facility before they are discharged to their homes. These likely outcomes of patients who require long-term ventilation should be discussed with patients and their families to assist them in making informed decisions.
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Clinical Trial
Effects of inhaled nitric oxide in patients with hypoxemia and pulmonary hypertension after cardiac surgery.
Cardiopulmonary bypass can increase pulmonary vascular tone and decrease ventilation-perfusion matching by impairing the pulmonary endothelial production of nitric oxide. ⋯ Inhalation of nitric oxide selectively decreases pulmonary vascular tone and increases ventilation-perfusion matching in patients with persistent pulmonary hypertension and hypoxemia after surgery requiring cardiopulmonary bypass. Inhalation of nitric oxide may be a valuable adjunctive therapy for these patients.
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Although nurse educators and nurse managers have disagreed about which clinical competencies are necessary for new graduates to begin working in critical care, the competencies are in need of revision and reassessment. ⋯ The agreement between nurse educators and nurse managers supports a competency list for baccalaureate nursing curricula and hospital inservice programs to integrate new graduates into critical care.
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To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. ⋯ Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.