Aust Crit Care
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Review
Non-invasive positive pressure ventilation in acute respiratory failure: providing competent care.
Non-invasive positive pressure ventilation (NPPV) has been used as an alternative strategy to provide ventilatory support for patients with acute respiratory failure. Most studies demonstrate that the use of NPPV in acute respiratory failure results in a reduction in the need for endotracheal intubation and an overall survival advantage. However, current evidence, in the form of randomised controlled trials, suggests that these benefits may be restricted to patients suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD). ⋯ Clinical outcomes and thus valid comparisons with alternate methods of ventilatory support can only be made if attention is paid to the clinical indications for the application of NPPV and patient subgroups it is used to treat and the level of competence of care givers in its application and delivery. One essential element of competence is the establishment of an appropriate knowledge base and the development of clinical practice guidelines. This literature review identifies the current indications for NPPV and the relevant information for developing clinical practice guidelines for the management of this form of ventilatory support.
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Research findings over the last 20 years show that critical care nurses (CCNs) continue to underestimate and under medicate their patients' pain, despite an allegedly strong commitment to pain relief. This literature review investigates the determinants of CCNs' pain assessment and management behaviours. Fishbein and Ajzen's theory of reasoned action' and Ajzen's theory of planned behaviour have been used as models to facilitate understanding of this phenomenon. ⋯ Through an analysis of the behavioural determinants following the models described by Fishbein and Ajzen, strategies can be formulated to address CCN deficiencies, improve patient outcomes and satisfaction with nursing care and CCN fulfilment. Cervantes was quoted as saying "It's a long way from saying to doing". This report aims to improve on this idea.
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Although low molecular weight heparin (LMWH) is increasingly being used in the treatment of acute coronary syndrome (ACS), unfractionated intravenous (IV) heparin infusion is still widely used in Australian hospitals for the treatment of ACS. This paper evaluates the effectiveness of a non-weight based heparin regimen in achieving a therapeutic activated partial thromboplastin time (aPTT) within 24 hours of IV heparin commencement. A sequential retrospective chart review of 99 medical records of ACS patients in a district hospital in south western Sydney, Australia, was performed. ⋯ Comparison of therapeutic aPTT and non-therapeutic aPTT groups revealed that body weight was the only factor that was significantly different in the two groups. Patients who reached the therapeutic aPTT threshold within 24 hours weighed significantly less (mean body weight: 70.3 kg versus 80.3 kg) than those who did not reach the therapeutic threshold within 24 hours of heparin commencement (t = 3.80, d.f. = 86, p < 0.001). Given that a significant proportion of patients who require IV heparin therapy exceed the 70 kg body weight, the findings from this study suggest that a non-weight based heparin regimen is ineffective in the rapid achievement of therapeutic aPTT.