American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Clinical Trial
Effect of lateral position on arterial and venous blood gases in postoperative cardiac surgery patients.
Investigators have suggested that lateral position may have clinically significant effects on oxygenation in cardiac surgery patients. Presence of lung disease and type of cardiac surgery may be important considerations. ⋯ The results of this study support those of previous research, which reported lower PaO2 in postoperative coronary artery bypass graft patients in the left lateral position. Mean differences in PaO2 were small, suggesting that the known benefits of lateral positioning in the early postoperative period outweigh the potential risks.
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A range of neuro-cognitive sequelae, from mild intellectual impairments to brain death, have been reported in survivors of aborted sudden cardiac death. ⋯ Our results suggest that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles.
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Despite a strong national commitment to excellence in healthcare, the available resources are limited. Cardiac surgery consumes more healthcare resources than any other single treatment. It is imperative that healthcare professionals evaluate the traditional methods used to deliver quality care. ⋯ A decrease in intubation time, respiratory infections, wound infections, laboratory procedures, length of stay, and costs has been demonstrated. In a follow-up patient and family survey, high satisfaction with nursing care, patient and family education, and length of hospitalization has been voiced. Anticipated goals have been exceeded and improvements in standards continue to be made.
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The blood-conserving technology of continuous intra-arterial blood gas monitoring has recently been introduced into the field of critical care. This type of monitoring is a real-time method for concomitantly assessing oxygenation, ventilation, and acid-base status in pediatric and adult populations through an indwelling (in vivo) sensor residing in a peripheral artery. This article examines the technology underpinning in vivo blood gas monitoring and reviews research documenting clinical performance, as well as benefits and clinical applications of three-analyte systems in critically ill patients. ⋯ Although most clinical research in critically ill adults has revealed good clinical performance of in vivo blood gas sensors, reports of aberrant blood gas values and sensor problems remain; no reports have been published to date evaluating continuous intra-arterial blood gas monitoring in children or infants. Many benefits of this technology have been postulated, and research examining its effect on patient and cost outcomes in critically ill populations is pending. Clinicians in critical care must keep abreast of this emerging technology, because it holds significant potential for improving the quality of care and outcomes of critically ill patients.
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Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. ⋯ Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.