Nursing in critical care
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Nursing in critical care · Sep 2013
Review Case ReportsVentilator auto-cycling from cardiogenic oscillations: case report and review of literature.
Brain death is the total loss of all brain and brain stem functions, and its diagnosis is often confirmed by an apnoea test, which relies on disconnecting the patient from the ventilator. Auto-triggering or auto-cycling is defined as a ventilator being triggered in the absence of patient effort, intrinsic respiratory drive or inspiratory muscle activity. Ventilator auto-triggering could delay the diagnosis of brain death leading to unnecessary admission for the patient and false hopes of recovery for the family. ⋯ This case is presented to arouse the awareness of the medical staff and nurses to this phenomenon, which can mimic an intrinsic respiratory effort in patients allegedly diagnosed with brain death. Along with this case report, we review the English language publications for similar cases.
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Nursing in critical care · Sep 2013
ReviewCentral venous oxygen saturation: analysis, clinical use and effects on mortality.
The aim of this literature review was to provide a clear definition of central venous oxygen saturation (ScvO₂), highlight the differences between ScvO₂ and mixed venous oxygen saturation (SvO₂), show how it can be used clinically and the effect central venous oxygen saturation has on mortality. ⋯ This literature review will highlight to nursing staff within the critical care environment the importance of central venous oxygen saturation measurement and interpretation. By raising awareness of the importance of this measurement it is hoped nursing staff will be proactive in both taking this test and analysing the results, therefore facilitating better care for the septic, critically ill patient and improving outcomes for these patients.
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Nursing in critical care · Sep 2013
Case ReportsNursing challenges with a severely injured patient in critical care.
Patients with severe, multiple, traumatic injuries are challenging to manage in critical care. Early identification of injuries and optimal resuscitation is essential for favourable outcomes. Trauma-related haemorrhage can lead to the lethal triad of hypothermia, coagulopathy and acidosis. Many trauma patients require urgent haemorrhage control and structural fixation through operative intervention. However, metabolic derangement and cardiovascular instability may delay surgery, resulting in an ongoing cycle of deterioration. Damage control surgery (DCS) may be used as a temporizing measure until the patient is stabilized in critical care. The aim of this case study is to discuss the complex issues faced in the critical care management of a severely injured patient. ⋯ Evidence and guidelines are required to support DCS for critical care patients with multiple, conflicting injuries including spinal fractures. For patients with delayed surgical intervention, rotational bed therapy may assist critical care nurses in meeting needs.
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Nursing in critical care · Jul 2013
Nurses' perceptions of unpleasant symptoms and signs in ventilated and sedated patients.
To describe intensive care nurses' perceptions and assessments of unpleasant symptoms and signs in mechanically ventilated and sedated adult intensive care patients. ⋯ A deeper understanding of unpleasant symptoms and signs focused in learning activities may help nurses to recognize patients' early problems and allow targeted interventions. A more active stimulus-response assessment of ICU patients is required to detect oversedation, critical illness polyneuropathy/myopathy and hypoactive delirium. Assessment tools should reflect both the patient's tolerance of various unpleasant symptoms and the level of consciousness.
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Nursing in critical care · Jul 2013
Multicenter Study Comparative StudySedation practice in Nordic and non-Nordic ICUs: a European survey.
A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. ⋯ Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.