Nursing in critical care
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Nursing in critical care · Jul 2009
Review Comparative StudyHeparin versus citrate for anticoagulation in critically ill patients treated with continuous renal replacement therapy.
Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients (Gabutti et al., 2002). Critical illness increases the likelihood to both coagulation and bleeding, making anticoagulation for CRRT problematic. ⋯ The studies examined lacked reference to the power of the studies and strength in the presentation of the results. Because of the lack of reliability in the studies, it would be suggested that further research is needed on this topic in order to produce rigorous high-quality reviews with limited bias. The use of citrate, as with all treatments in clinical practice, should be used with caution and assessed on an individual patient basis. Reviewing this evidence helps to gain an insight into different treatment options available, identifying some of the risks and benefits.
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Nursing in critical care · Jul 2009
ReviewAcute kidney injury and renal replacement therapy in the intensive care unit.
Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof. ⋯ AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required.
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Nursing in critical care · Jul 2009
ReviewWeaning from ventilation--current state of the science and art.
Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols. Key to this work is the role of the critical care nurse. ⋯ Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.
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Nursing in critical care · Jul 2009
Randomized Controlled TrialEarplugs improve patients' subjective experience of sleep in critical care.
This study aimed to determine the effects of earplug use on the subjective experience of sleep for patients in critical care. ⋯ The negligible cost and low level of invasiveness of earplugs makes this preferable as a primary intervention to promote sleep while avoiding unnecessary sedating medications.