Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2001
ReviewAnticoagulation in continuous renal replacement therapy.
Continuous renal replacement therapy (CRRT) is a specialized intervention that is managed largely by critical care nurses who are educated in the theoretical and practical aspects of the therapy. CRRT is most commonly indicated for hemodynamically unstable patients who have acute renal failure and a narrow margin of tolerance for the rapid fluid shifts associated with traditional dialysis. ⋯ Nurses at the bedside must be expert in both managing CRRT and assisting in identifying patients who may be at potential risk when this form of treatment is in place. An overview of possible anticoagulants for use in CRRT is outlined in this article.
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Dynamics (Pembroke, Ont.) · Jan 2001
ReviewA review of neuromuscular blockade in the critically ill patient.
The continuous administration of neuromuscular blocking agents is thought to be associated with a number of adverse effects and complications, including post-paralytic syndrome (characterized by persistent paralysis), muscle weakness, and the inability to wean from the ventilator despite discontinuation of the therapy. Consequently, clinical objectives emphasize administering only the dose necessary to optimize the effect of the drug and for the shortest possible time. This article provides an overview of the administration of neuromuscular blocking agents, from the perspective of a critical care pharmacist and critical care nurses. The complexities associated with pharmacological paralysis in critically ill patients warrants the comprehensive approach to care that multidisciplinary team members can provide.
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Dynamics (Pembroke, Ont.) · Jan 2001
Randomized Controlled Trial Clinical TrialCost analysis of an intensive home follow-up program for first-time post-myocardial infarction patients and their families.
The general goal of this research was to determine the effectiveness of a home follow-up program in order to acquire guidance in how to plan the future structure and contents of post-myocardial infarction (MI) patients' care and rehabilitation. The specific aim of this study was to evaluate the cost-effectiveness of the program in reducing the rate of rehospitalization of first-time post-MI patients when measured at six weeks and six months post-discharge. ⋯ Intensive home follow-up provided a cost-effective alternative to traditional cardiac rehabilitation programs; however, a larger study is required to assess the generalizability of the results and long-term cost effectiveness.
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Dynamics (Pembroke, Ont.) · Jan 2001
Case ReportsThe use of high-frequency oscillatory ventilation in adult ARDS patients.
Current ventilatory objectives for adults with ARDS include maximizing gas exchange while minimizing lung injury. To this end, high-frequency oscillatory ventilation (HFOV), a mechanical ventilation strategy that simultaneously avoids end-inspiratory alveolar overdistension and end-expiratory alveolar collapse, has been recommended. HFOV meets these criteria from a theoretical perspective, however, is without the benefit of a prospective randomized clinical trial of CMV versus HFOV to demonstrate that effect. This article provides an overview of high-frequency oscillation, followed by an illustration of how it was applied in the case of a 43-year-old patient who developed respiratory failure 24 hours post-Caesarean section.
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Dynamics (Pembroke, Ont.) · Jan 2001
Transfer stress and medical intensive care patients and family members.
To explore the phenomenon of transfer stress in medical intensive care (MICU) patients and family members. ⋯ Transfer stress frequently occurs in MICU patients and family members and should be an area of concern for health care professionals.