Aust Crit Care
-
The aim of this survey was to review the practice of sedation for adult artificially ventilated patients in Australian intensive care units. In particular, the survey sought to investigate the drugs used, how they were administered, who was responsible for the administration, how sedation was assessed, and if, in the opinion of charge nurses, complications were occurring as a result of their practice. Questionnaires were sent by post to the clinical nurse consultants (CNCs) in charge of 72 units containing five or more beds, as identified in the Hospital Health Services Yearbook. ⋯ It appears that there is no consistent method of assessing the level of sedation in critically ill ventilated patients and that over-sedation is common. Therefore, it is recommended that clinicians investigate the possibility of introducing sedation scales in their units. However, the efficacy of such scales in ensuring a more appropriate level of sedation needs to be researched.
-
Acute respiratory distress syndrome (ADRS) is a severe, life-threatening consequence of certain pulmonary and systemic insults. It is thought to result from a dramatic change in the permeability of the alveolar-capillary membrane, allowing the movement of fluid and proteins into alveolar air spaces. ⋯ However, the poor compliance of the ARDS-affected lung can greatly increase the risk of ventilator induced lung injury. This has led to a concern that traditional ventilation strategies may in fact be perpetuating the very conditions they attempt to compensate for.
-
Critical care services are an identified, resource-intensive component of health-care provision. Examining cost containment and clinical effectiveness in this specialty is therefore highly appropriate, although difficult to achieve in practice. The studies reviewed in this paper utilised various methodologies to capture different components of service and patient costs. ⋯ Differing methods and data collection resulted in a limited comparative analysis, but issues requiring further research are highlighted. Funding of ICU services in Australia and nursing staff costs are also discussed. Future research will be aided by further sophistication in clinical information systems and the desire for clinicians to examine the link between costs and outcomes of the different activities pursued within the ICU.
-
Comparative Study Clinical Trial Controlled Clinical Trial
Assessment of the agreement between cardiac output measured by bolus thermodilution and continuous methods, with particular reference to the effect of heart rhythm.
Cardiac output (CO) is a fundamentally important haemodynamic parameter and its continuous measurement has the potential to enable early recognition of haemodynamic trends and earlier therapeutic response. A method of continuous cardiac output (CCO) monitoring is now available for clinical use. The accuracy and reliability of this method has been confirmed in clinical trials but not, to our knowledge, in the presence of abnormal heart rhythms. ⋯ The bias of the two measurements was -0.35 l/min for sinus rhythm, -0.19 l/min for sinus tachycardia and -0.12 l/min for atrial flutter/fibrillation. Increased temperature and heart rate did not affect measurement agreement. In conclusion, the agreement between the bolus and continuous methods is clinically acceptable and is unaffected by the heart rhythms of sinus rhythm, sinus tachycardia and atrial flutter/fibrillation.