Nursing in critical care
-
Nursing in critical care · Sep 2008
ReviewThe LoTrach system: its role in the prevention of ventilator-associated pneumonia.
To discuss the development of the LoTrach system in light of current evidence around the prevention of ventilator-associated pneumonia (VAP) and its practical application in the intensive care setting. ⋯ The LoTrach system has been designed to facilitate the provision of a number of evidence-based interventions that have been shown to reduce VAP. Pulmonary aspiration is ubiquitous with conventional cuffs but prevented by the cuff of the LoTrach system when held at a constant and safe pressure against the tracheal wall with a cuff pressure controller. Other aspects incorporated in the ETT are aimed at clearing the secretions from the subglottic space, preventing tube occlusion and accidental extubation, and avoiding damage to the airway. In this way the LoTrach system employs a multifactorial approach to the prevention of VAP and the cost savings from LoTrach rather than a standard ETT will be considerable because of an average 3 day reduction in ICU length of stay related to this. It thus has the potential to be a very useful tool in the ICU setting in the prevention of VAP.
-
Nursing in critical care · Sep 2008
Asymmetry in the intensive care unit: redressing imbalance and meeting the needs of family.
The purpose of this study was to develop a way for nurses to understand how they negotiate and work with families in the intensive care unit (ICU). ⋯ Positive steps to redress asymmetrical relationships can help ensure that family care is better integrated into ICU practice.
-
The aim of the review was to consider the relationship between delirium and aspects of sedative and analgesic drug use in mechanically ventilated intensive care patients. The basis for routine delirium screening and the implications for nurses are discussed along with a brief outline of the treatment of delirium. ⋯ Sedative and analgesic drugs have an important role in the prevention and treatment of delirium in intensive care patients. Routine delirium screening should be included as part of sedation monitoring practice. When detected, treatment is focused on the prompt correction of precipitating factors, non-pharmacological interventions and appropriate drug therapy for symptom control.
-
Nursing in critical care · Jul 2008
ReviewManaging a good death in critical care: can health policy help?
This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy. ⋯ A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose.
-
Nursing in critical care · Jul 2008
Implementing a ventilator care bundle in an adult intensive care unit.
Ventilator-associated pneumonia (VAP), in addition to causing distress to patients, is associated with increased length of stay in intensive care, higher rates of morbidity and mortality and pressure on critical care capacity and costs. A care bundle approach for the management of ventilated patients can reduce the risk of VAP. ⋯ Daily care bundle audits showed a positive impact on compliance. However, without a robust method to collect data on prevalence of VAP, the impact of the care bundles on improving outcomes for this aspect of care is unknown.