American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Clinical Trial
Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients.
When liver transplant candidates and recipients suffer from pulmonary complications of immobility, the results can be life-threatening. Continuous lateral rotation therapy has been reported to decrease complications of immobility. ⋯ Although continuous lateral rotation therapy did not affect duration of mechanical ventilation, length of stay, or incidence of atelectasis, it was effective in decreasing the incidence of, and increasing onset time to, lower respiratory tract infection in the liver transplantation population.
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Ventilator-dependent patients average 11,419 daily in US acute care hospitals. ⋯ Of 174 subjects, 120 were weaned from mechanical ventilation. There were no differences in maximum inspiratory pressure, minute ventilation, or ventilatory capacity between successful and unsuccessful candidates. There were differences in serum albumin level, rapid shallow breathing index, fraction of inspired oxygen, and 24-hour fluid balance. Among subjects who were weaned, the duration of mechanical ventilation was significantly longer in those with left ventricular dysfunction (n = 53; 29.1 +/- 25.2 days) than in those with normal left ventricular function (n = 67; 21.1 +/- 18.1 days). Subjects who were weaned received a greater number of drugs to treat heart failure (1.46 +/- 1.24) than did those who were not (0.77 +/- 1.04). CONCLUSIONS Many weaning parameters do not differentiate patients able to be weaned from those who are unable. The presence of left ventricular dysfunction, number of drugs used to treat heart failure, serum albumin level, and 24-hour fluid balance were associated with weaning success and/or duration of mechanical ventilation in adults requiring prolonged mechanical ventilation.
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Despite the frequency of intrahospital transport of critically ill patients, little research has been done on this topic and the findings are contradictory. ⋯ Transport outside the intensive care unit places the critically ill patient at additional risk. Although transport is often unavoidable, its risks versus benefits should be carefully and collaboratively evaluated for every patient prior to making the decision for transport.
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Hyperventilation is a frequently used method for inducing hypercarbia in neurosurgical patients. This practice requires careful carbon dioxide monitoring that might be replaced by a less expensive and less invasive alternative to arterial blood gas monitoring. ⋯ In this patient sample, changes in end-tidal carbon dioxide values did not accurately reflect changes in arterial carbon dioxide tension levels in the intensive care setting. Further technological advances in noninvasive carbon dioxide monitoring may lead to a significant cost savings over traditional arterial blood gas analysis.