Nursing in critical care
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Nursing in critical care · Nov 2007
Controlled Clinical TrialEarplugs and eye masks: do they improve critical care patients' sleep?
Disturbed sleep and sleep deprivation is common in patients in critical care settings. Noise and inappropriate use of light/dark cycles are two of the causes of sleep interruptions. The purpose of the study was to evaluate eye masks and earplugs to help control patients' exposure to noise and light within the critical care environment. ⋯ At a cost of 2.50 pounds sterling/patient, earplugs and eye masks were a relatively cheap intervention with notable improvements for some critically ill patients. Further research is required with a larger sample size, plus an examination of both earplugs and eye masks separately. Offering patient's earplugs and eye masks to improve sleep should be considered as a matter of routine nursing practice, this should include time to show patients how to use and try them out for comfort.
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Nursing in critical care · Nov 2007
Randomized Controlled TrialReducing the risk of ventilator-acquired pneumonia through head of bed elevation.
It has been suggested that placing critically ill ventilated patients in a semirecumbent position minimizes the likelihood of nosocomial pneumonia. ⋯ There was a trend towards a reduction in VAP in the patients nursed at 45 degrees. However, because of the sample size this difference did not reach statistical significance.
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Nursing in critical care · Sep 2007
ReviewUsing pressure-volume curves to set proper PEEP in acute lung injury.
The evolution of respiratory care on patients with acute respiratory distress syndrome (ARDS) has been focused on preventing the deleterious effects of mechanical ventilation, termed ventilator-induced lung injury (VILI). Currently, reduced tidal volume is the standard of ventilatory care for patients with ARDS. The current focus, however, has shifted to the proper setting of positive end-expiratory pressure (PEEP). ⋯ New methods used to identify optimal PEEP, including tomography and active compliance measurements, are currently being investigated. In conclusion, we believe that the most promising method for determining proper PEEP settings is use of the UIP of the deflation limb. However, tomography and dynamic compliance may offer superior bedside availability.
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Nursing in critical care · Sep 2007
ReviewPhysiological risk factors, early warning scoring systems and organizational changes.
Currently, medical and surgical wards tend to have a higher number of sicker and more dependent patients. There is also a growing recognition that several indicators of acute deterioration are being missed, leading to adverse consequences for the patients. As a result, many initiatives have been designed to try to reduce these consequences, including the development of early warning scoring or track and trigger systems and medical response and critical care outreach teams. ⋯ The impact of outreach teams and medical emergency teams has yet to be fully defined. For clinical practice, this means that care must be taken when developing and implementing these changes. The rigour of the development process needs to be considered along with reflection upon how to best meet local requirements.
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Nursing in critical care · Sep 2007
Implementing the severe sepsis care bundles outside the ICU by outreach.
Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. ⋯ This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle.