Dynamics (Pembroke, Ont.)
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Continuous renal replacement therapy is a treatment option that is especially suited to the critical care setting. Greater hemodynamic stability, the ongoing ability to optimize fluid balance, and the potential for clearing inflammatory mediators are among the frequently cited advantages continuous veno-venous dialysis modalities offer over traditional intermittent therapies. ⋯ The blood is then returned to the patient, without large fluctuations in electrolyte and acid-base balance or renal hypoperfusion. This article includes a review of acute renal failure, a discussion of the indications for continuous renal replacement therapy, the mechanisms of action of this therapy, and the nursing considerations.
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Widespread acceptance of the importance of discontinuing ventilator support at the earliest possible opportunity has resulted in a number of efforts to develop a standardized approach to extubation. The implementation of an extubation protocol designed for the medical/surgical intensive care unit of a university-affiliated hospital followed a series of educational sessions that were open to all members of the multidisciplinary team. ⋯ A clinical outcome was defined as the percentage of patients who required reintubation within 48 hours. The protocol has been well-received by the ICU team and has become an established component of ventilator management.