Aust Crit Care
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Randomized Controlled Trial
Exploring the impact of augmenting sedation assessment with physiologic monitors.
Pharmacological sedation is a necessary tool in the management of critically ill, mechanically ventilated patients. The intensive care unit (ICU) sedation strategy is to use the least amount of medication to meet safety and comfort goals. Titration of pharmacological agents is currently guided by clinical assessment tools. The purpose of this study was to determine whether the addition of a neurophysiological monitor, bispectral index (BIS), aided the ICU nurse in reducing the amount of drug used, compared to a clinical tool alone, in a general critical care population. ⋯ The clinical evaluation of depth of sedation remains the most reliable method for the titration of pharmacological sedation in the critical care unit. However, BIS-augmented assessment is helpful in reducing the amount of propofol and narcotic medication used and may be considered an adjunct when these agents are utilised.
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In the ICU, SpO2≥96% are regularly targeted implying that more oxygen may be given than desirable. To reduce exposure to hyperoxia a conservative oxygen therapy protocol (targeted SpO2 90-92% using lowest FiO2) for mechanically ventilated patients was introduced in a single tertiary ICU in September 2012. ⋯ Intensive care clinicians readily accepted the introduction of a conservative oxygen therapy protocol into their practice. Most respondents found conservative oxygen therapy easy and not stressful to perform. Further evaluation the administration of oxygen therapy, its management by intensive care clinicians and possible impact on outcome for mechanically ventilated patients appears well accepted by clinical staff.
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Continuing education for intensive care unit nurses on invasive mechanical ventilation is fundamental to the acquisition and maintenance of knowledge and skills to optimise patient outcomes. ⋯ Registered nurses are commencing their ICU experience with limited knowledge of invasive MV therefore the education provided within the ICU workplace becomes fundamental to safe and effective practice. The perception of continuing education by ICU nurses from this research is positive regardless of level of ICU experience and may influence the type of continuing education on invasive MV provided to ICU nurses in the future, not only in the ICU involved in this study, but other units throughout Australia.
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Medical Emergency Teams (METs) have been developed and implemented with the aim of improving recognition of and response to deteriorating patients. Yet, METs are often not activated or used effectively by nursing staff. The reasons for this are not fully understood. ⋯ This work identifies why nurses do not activate METs appropriately. This delay in MET activation potentially exposes the deteriorating patient to suboptimal care and increases the risk of adverse events.