American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Randomized Controlled Trial Clinical Trial
Chest tube stripping in pediatric oncology patients: an experimental study.
Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue. ⋯ Stripping of chest tubes as a routine postoperative measure is questioned.
-
Bedside ST segment monitors analyze only one precordial lead and one, two or three limb leads. The precordial lead V1 (or V6 if V1 is not feasible) has been recommended for bedside monitoring because of its value in diagnosing cardiac rhythms with a wide QRS complex. Thus, the remaining lead choices for ST monitoring are limited to the six limb leads. ⋯ 12-lead electrocardiogram recordings during coronary angioplasty balloon inflation provide excellent guidance for postprocedure lead selection decisions. The most valuable limb leads for detecting ischemia due to abrupt artery closure are leads III and aVF, either of which is more sensitive than the routinely monitored lead II. The precordial leads valuable for arrhythmia monitoring, V1 and V6, are seldom sensitive in detecting ischemia in these patients.
-
Comparative Study
Effects of lung hyperinflation and presence of positive end-expiratory pressure on arterial and tissue oxygenation during endotracheal suctioning.
To explore the effects of endotracheal suctioning on mixed venous oxygen tension and other measures of arterial and tissue oxygenation, to determine if these would be clinically useful outcome measures of endotracheal suctioning. ⋯ Continuous measurement of mixed venous oxygen tension allows the calculation of oxygen delivery and oxygen extraction ratio, which provide a better estimation of the effects of endotracheal suctioning on tissue oxygenation than arterial oxygen tension alone.
-
To determine the effect on oxygen saturation of instilling a saline bolus into artificial airways prior to suctioning, as measured by pulse oximeter. ⋯ These results indicate that instilling saline prior to suctioning has an adverse effect on oxygen saturation. These results support the recommendation that the practice of instilling saline prior to suctioning should be abandoned as a routine procedure. More study is needed to investigate whether a specific group of patients may actually benefit from this procedure.