Aust Crit Care
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Evidence presented in the anaesthetic and emergency medical services literature warns of the possibility of accidental or insidious displacement of endotracheal tubes in intubated patients. In particular, there is evidence that head movement in intubated patients can lead to displacement of the distal tip of an endotracheal tube in the trachea while its depth markings remain fixed in relation to the patient's lips or teeth. Immobilisation of the heads of all intubated patients should be considered, to prevent the possibility of accidental endotracheal tube displacement. In addition, all intubated patients must be clinically assessed for proper endotracheal tube placement and maintenance of adequate ventilation after every movement during resuscitation and diagnostic measures.
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Patient care within an intensive care unit (ICU) can be a difficult and stressful task for even the most experienced and skilled critical care nurse. Good communication between the patient, relatives and nurse is integral to quality care of the patient and should extend to the entire health-care team. This article reviews the literature on nurse-patient communication in the ICU. ⋯ The literature indicates that nurses communicate extremely poorly with patients, despite a high level of knowledge and skill with respect to communication. Tentative explanations of high stress levels, a preoccupation with physical care and technology, and the attraction to critical care areas of nurses with specific personality types are discussed as possible reasons for this. The need for further research into, and attempts to alleviate, this problem is clearly demonstrated.
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Review
Use of continuous positive airway pressure (CPAP) in the critically ill--physiological principles.
CPAP therapy helps improve oxygenation in patients who are awake and able to maintain a good respiratory drive. In many cases this means that intubation and ventilation can be avoided. The main goals of CPAP are to minimise alveolar collapse, improve compliance, decrease work of breathing and improve ventilation/perfusion matching. ⋯ As CPAP has developed into a common therapy for patients with respiratory failure, it is essential that nurses using this therapy are familiar with the equipment and the physiological effects it produces. Assessment and management of the patient receiving CPAP therapy are also important. This paper will address the physiological principles of CPAP therapy so that nurses working with critically ill patients receiving CPAP therapy understand the system and are accurate and astute in their respiratory assessment, in order to provide optimum care.
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Review
Measuring the health outcomes of general ICU patients: a systematic review of methods and findings.
Studies that have measured patient outcomes following a critical illness and admission to a general intensive care unit (ICU) have used a variety of methods and variables. Traditionally, the measures have been mortality and morbidity, but they now also include assessment of indices such as functional status, health status, quality of life and patient satisfaction. This review paper examines 31 previously published primary studies that measured patient outcomes from adult general ICUs. ⋯ In addition, the heterogeneity of the ICU population in terms of age, acuity and diagnoses complicates any potential comparisons. There is an opportunity for further studies in this area by nurse researchers, in either intra- or multidisciplinary teams. Future studies should incorporate rigorous methodologies and a triangulated approach, in order to adequately examine patient outcomes following a critical illness and admission to a general ICU.
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Liquid ventilation, an idea currently being trialled in the United States, is increasingly being discussed as a possible future trend in ventilation. A review of the available literature indicates that this treatment provides effective gas exchange and has a number of potential advantages. ⋯ While yet to be seen in this country, liquid ventilation may be introduced in the future. If it is, those caring for patients treated in that way will require knowledge of the mechanics and physiological changes involved, as well as the potential hazards of this modality.