International anesthesiology clinics
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In this review, traditional weaning parameters, integrative indexes, and experimental methods of predicting weaning outcomes have been reviewed. All have limitations; however, judicious application of these parameters may guide clinical decisions regarding timing of weaning trials. Of the parameters reviewed, the RSBI has several advantages and may identify patients who are candidates for weaning. ⋯ Most patients will be successfully extubated after a single SBT, and weaning methods that focus on sequential decrements in ventilator support appear to needlessly prolong ventilation. However, for patients who fail, identification of potential causes of continued ventilator dependence should focus on the various pathophysiological causes outlined. Although a number of patients will require prolonged ventilator support beyond the critical care setting, the growing experience with this population demonstrates that a large percentage have favorable outcomes.
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Int Anesthesiol Clin · Jan 1999
Nursing education, competency, and role in intravenous conscious sedation.
The advent of new hospital policies addressing analgesia and sedation motivates the nursing education department to implement an education plan for training RNs in the safe administration of medications that produce analgesia and sedation according to hospital policies. Learning materials must be procured or written, classroom content delineated, and a plan to precept all RNs who may be involved in IVCS procedures arranged. ⋯ The RN's role in collecting quality monitoring data is crucial. The development of forms that include all required aspects of patient assessment, care, and monitoring promotes compliance with hospital policy.
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Choose your patients carefully. Check and understand your equipment. Be vigilant and prepared for the unexpected event. ⋯ Have clearly defined personal and departmental plans to deal with emergency situations. Use medication judiciously; you cannot take it out but you can always give more. The use of reversal agents should never be routine.