Nursing in critical care
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Nursing in critical care · May 2007
Review of ICU nutrition support practices: implementing the nurse-led enteral feeding algorithm.
Many intensive care units (ICUs) have standard feeding protocols which promote safe early initiation of enteral feeding. The use of these protocols has been shown to increase the incidence of enteral feeding and achieve greater adequacy of nutrition support. A multidisciplinary working party developed and implemented a nurse-led enteral feeding algorithm which enabled senior nursing staff to set safe and nutritionally adequate target feed volumes based upon patient body weight. ⋯ Despite this finding, 60% of patients were actually receiving the correct feed regimen. If the nurse-led enteral feeding algorithm is wholly adhered to, the ICU dietitian need not formally assess every ICU patient. Nursing staff require further support in assessing patient body weight alongside an ongoing intensive educational programme for the multidisciplinary team and regular reaudit.
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Nursing in critical care · May 2007
Commentary: Saline versus Albumin Fluid Evaluation (SAFE) Investigators (2006). Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study.
The objectives of this study were to determine whether outcomes of resuscitation with albumin or saline in the intensive care unit (ICU) depend on patients' baseline serum albumin concentration. In this study we analyse data from a double-blind, randomized controlled trial. ICUs of 16 hospitals in Australia and New Zealand were included. ⋯ No significant interaction was found between baseline serum albumin concentration as a continuous variable and the effect of albumin and saline on mortality. No consistent interaction was found between baseline serum albumin concentration and treatment effects on length of stay in the ICU, length of hospital stay, duration of renal replacement therapy or duration of mechanical ventilation. The outcomes of resuscitation with albumin and saline are similar irrespective of patients' baseline serum albumin concentration.
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Nursing in critical care · Mar 2007
Comparative StudyNurses' and physicians' viewpoints regarding children visiting/not visiting adult ICUs.
Allowing children to visit adult intensive care units (ICUs) has been an area of controversy. There is a lack of recent research dealing with visits by children and physicians' views and whether differences exist between the views held by nurses and physicians regarding visits by children. The aim of this study was to describe and compare reasons given by nurses and physicians for restricting visits by children to a relative hospitalized in an adult ICU. ⋯ Risks of negative effects on the children's health by visiting patients were also stated. Nurses and physicians still restrict children's visits to adult ICUs for a number of reasons, and nurses' and physicians' views on children visiting differ and so also the views within each professional group. The differences in views show that the dynamics are complicated and this could be attributed to a lack of a common view of care, which prevents family-centred care that includes children from being practised.
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Nursing in critical care · Mar 2007
Extracorporeal circuit pressure profiles during continuous venovenous haemofiltration.
Continuous renal replacement therapy machines are capable of providing continuous pressure measurements at different points of the extracorporeal circuit. This study investigates the pattern of circuit pressure changes during high-volume continuous venovenous haemofiltration (CVVH) with regional anticoagulation with anticoagulant citrate dextrose in formula A. Extracorporeal circuit pressures during 91 treatments of CVVH were analysed. ⋯ Poorly functioning catheters tended to have a higher baseline PA (median: -33 versus -25.5) than in those without catheter problems; however, the difference was not statistically significant (p= 0.13). (d) A rise in PBE and PFD followed by changes in PD2 and TMP were noted in a treatment disrupted because of air detection chamber clotting. Distinct patterns of extracorporeal circuit pressures were present in patent and disrupted CVVH circuits. We suggest that the pattern of pressure profiles, not absolute values, may be more relevant in clinical practice.