Nursing in critical care
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Nursing in critical care · Nov 2006
ReviewIntra-aortic balloon counterpulsation complicated by limb ischaemia: a reflective commentary.
Intra-aortic balloon counterpulsation (IABC) is widely used to support the failing myocardium, particularly in patients with a background of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). CS is primarily due to left ventricular failure and is the most serious complication of AMI. Using Driscoll's 'What?' reflective model to guide critical thinking, an incident involving a patient who required IABC following AMI is explored. ⋯ Nurses and health care professionals who have the responsibility of caring for these patients need to be adequately trained in order to maintain a high standard of care. However, there appears to be a lack of evidence-based guidelines determining the optimum frequency of limb observations to assess for limb ischaemia. Further evidence as to the timing of limb observations is required in order that protocols can be written to guide the practice.
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Nursing in critical care · Nov 2006
Retrospective analysis of renal transplantation outcomes in children admitted to a paediatric intensive care unit in Brazil.
Renal transplantation has been described as the main treatment for children with end-stage renal disease. Traditionally, infants and small children represented a high-risk group with poor allograft survival. However, studies conducted mainly in developed countries have been demonstrated improvements in allograft survival rates. ⋯ The occurrence of four or more complications was significantly associated with acute rejection (p= 0.009). In conclusion, the main outcomes of this study were similar to those observed in developed countries, in terms of acute rejections (52.3%), dialysis resumption (31.8%), graft loss (29.5%), chronic rejections (9.1%) and death (4.5%). Complications during PICU stay were significantly linked to the occurrence of acute rejection.
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Advances in medicine and changes in health care provision have resulted in increasingly innovative methods of delivering health care, such as the development of critical care outreach teams (CCOTs). These teams aim to respond to the needs of the critically ill patient, regardless of the patient's location within the acute hospital. The aim of this audit was to assess one aspect of the effectiveness of the Outreach team by examining the attitudes and opinions of the hospital clinical staff towards the outreach service provided. ⋯ In response to the findings, the number of hours per day in which the team operates has been increased. The findings demonstrated a belief by staff that the CCOT was instrumental in enhancing clinical care within the institution. While the findings of this audit are an informative addition to routine activity data, further studies are required to assess the acceptability of the service to patients and the impact of the service on patient outcomes.