Aust Crit Care
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Tracheostomy decannulation failure rate following critical illness: a prospective descriptive study.
Tracheostomy is a well established and practical approach to airway management for patients requiring extended periods of mechanical ventilation or airway protection. Little evidence is available to guide the process of weaning and optimal timing of tracheostomy tube removal. Thus, decannulation decisions are based on clinical judgement. The aim of this study was to describe decannulation practice and failure rates in patients with tracheostomy following critical illness. ⋯ Clinical assessments coupled with professional judgement to decide the optimal time to remove tracheostomy tubes in patients following critical illness resulted in a failure rate comparable with published data. Although reintubation and readmission to ICU was required in just over one third of failed decannulation episodes, there was no associated mortality or other significant adverse events. Our data suggest nurses need to exercise high levels of clinical vigilance during the first 24h following decannulation, particularly the first 4h to detect early signs of respiratory compromise to avoid adverse outcomes.
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The purpose of this study was to quantify the levels of anxiety experienced by Intensive Care Unit (ICU) patients just before transfer to the ward and then twice after transfer to the ward in order to test the hypothesis that anxiety levels would change over the three data collection periods. ⋯ This small study provides a start to the prospective mapping of anxiety levels on time of transfer and shortly after transfer from an ICU to the wards. It also provides information to researchers who want to examine ICU transfer anxiety. By understanding the anxiety experienced by ICU patients, nurses are better able to provide psychological support and thus more holistic care to this group of patients.
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Clinical practices or procedures based on the best available evidence are an essential resource within an intensive care unit (ICU). Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of staff with relevant skills to interrogate the literature. The aim of the Intensive Care Collaborative (ICC) project was to use the synergism of group processes to develop state-based clinical guidelines for six common intensive care practices - eye care, oral care, endotracheal tube management, suctioning, arterial line management, and central venous catheter (CVC) management. ⋯ This project has demonstrated a method for guideline development that is robust, incorporating evidence from research and clinical expertise utilising an objective egalitarian framework.
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As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. ⋯ This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. (1998) in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.
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The use of citrate to anticoagulate the Continuous Renal Replacement Therapy (CRRT) circuit has not been widely adopted in Australia as an alternative to heparin due to treatment complexity and risks of metabolic complications and availability of suitable solutions. However, interest persists in citrate anticoagulation as a viable alternative when heparin is either contraindicated or has failed to provide an adequate circuit lifespan due to dialyser clotting. ⋯ This paper describes a practical protocol for the delivery of regional citrate anticoagulation for pre-dilutional CVVHDf. The protocol maintains the flexibility in dialysis/haemofiltration dose prescription and advises on the requirement for monitoring and necessary adjustments to prevent the development of metabolic disturbances. This may assist regional citrate to achieve wider acceptance as an alternative anticoagulation strategy for critically ill patients.