AACN clinical issues
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AACN clinical issues · May 2003
Review Case ReportsCapnography application in acute and critical care.
The use of capnography has expanded over recent years. Currently, capnography is used in a variety of acute care settings. This article describes what capnography is and how it is used. ⋯ The multiplicity of clinical indications include detection of pulmonary embolism as well as malpositioned endotracheal/tracheal, gastric, and small bowel tubes. Capnography also provides clinicians with information regarding expiratory breathing patterns and assists in perfusion assessments such as those for cardiopulmonary resuscitation. Finally, case studies are provided to help the reader apply the concepts of capnography to a variety of acute care settings.
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AACN clinical issues · May 2003
ReviewDoppler-based hemodynamic monitoring: a minimally invasive alternative.
Doppler-based hemodynamic assessment affords a magnitude of diagnostic applications including evaluation of blood flow from the left ventricle. Doppler echocardiography, in the form of transthoracic and transesophageal echocardiography, allows for intermittent evaluation of hemodynamic information including aortic blood flow, global and regional wall motion, and valvular integrity. In the hands of a skilled operator, transthoracic and transesophageal echocardiography provides reliable cardiac output determinations. ⋯ In contrast, esophageal Doppler monitoring, a minimally invasive hemodynamic assessment tool, provides the ability for ongoing real-time hemodynamic assessment of the critically ill or compromised patient. This simple-to-use technology requires that a probe, similar in size and shape to a gastric tube, be inserted into the esophagus to obtain measurement of blood flow in the descending aorta. Hemodynamic variables such as cardiac output, preload, afterload, and contractility are measured or derived from the esophageal Doppler monitoring waveform.
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Continuous ST-segment monitoring has been shown to be beneficial for patients with acute coronary syndromes as well as for other patients in the intensive care unit (ICU). This article reviews the significance and value of continuous ST-segment monitoring with emphasis on the value of 12-lead ST-segment monitoring across the continuum of care from the emergency department, to the cardiac catheterization laboratory, the ICU, and the telemetry unit.
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AACN clinical issues · May 2003
ReviewRegional carbon dioxide monitoring: a different look at tissue perfusion.
Adequate tissue oxygenation is one of the main therapeutic goals for the critically ill patient. Until recently, the perfusion status of the critically ill and injured has been assessed by global indices such as blood pressure, heart rate, and urine output. However, these global parameters are inadequate in that they fail to demonstrate the actual perfusion status of a patient. ⋯ Because this region shows early signs of hypoperfusion and hypoxia, its monitoring provides for more effective and complete resuscitation. To that end, gastric tonometry offers a noninvasive means by which early symptoms of low flow can be determined, allowing for optimization of tissue perfusion and patient outcome. The most proximal segment of the gastrointestinal tract offers promising information regarding tissue perfusion with the use of sublingual capnography.
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AACN clinical issues · May 2003
Case ReportsWorking with respiratory waveforms: how to use bedside graphics.
Respiratory waveform graphics packages are available on many ventilators. Despite the prevalence of the waveforms, accurate interpretation and clinical application are not widespread. In fact, many clinicians find the waveforms confusing and choose to ignore them. This article provides a straightforward description of how to interpret the waveforms and suggests ways that the information might be used to improve clinical outcomes.