AACN clinical issues in critical care nursing
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AACN Clin Issues Crit Care Nurs · Aug 1990
High-frequency ventilation and extracorporeal membrane oxygenation.
Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. ⋯ Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO).
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AACN Clin Issues Crit Care Nurs · Aug 1990
Case ReportsExtracorporeal membrane oxygenation: current use and future directions.
Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. ⋯ Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.
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AACN Clin Issues Crit Care Nurs · Aug 1990
New techniques for weaning difficult patients from mechanical ventilation.
This article compares the weaning of challenging patients from mechanical ventilation to an exercise training program experienced by many athletes. Physically, the importance of the correction and maintenance of chronic health issues, nutrition, and hydration are explored. Psychologically, the degree of preparedness by both the patient and the health care team is presented. ⋯ Newer modes of ventilation, including pressure support ventilation, mandatory minute ventilation, and continuous flow, decrease the work of breathing, promote ventilator/patient synchrony, and provide a more dynamic weaning process. All of these modes promote exercise, and augment the physical and psychological components of weaning. Nursing considerations for successful weaning are offered.
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AACN Clin Issues Crit Care Nurs · Aug 1990
Noninvasive monitoring of the neonatal respiratory system.
The development and use of a large variety of nonivasive respiratory monitors have provided the neonatal intensive care unit clinician with invaluable tools for continuous monitoring. Thorough understanding of how each monitor functions, what it measures, and factors that contribute to monitor errors and injuries is vital for appropriate use of this technology and for proper interpretation of monitor values. ⋯ Noninvasive monitors have raised a controversy about home use of monitors to prevent sudden infant death syndrome--a review of National Institute of Health recommendations is helpful when cardiorespiratory monitoring is an issue. Family teaching and support are beneficial for discharge planning.
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AACN Clin Issues Crit Care Nurs · Aug 1990
Modes of ventilatory support and weaning parameters in children.
Pediatric respiratory therapy management has become increasingly complex. Mechanical ventilation has become a mainstay in neonatal and pediatric intensive care units. Thorough knowledge of the modes of ventilatory support and criteria for weaning are essential for the critical care nurse to anticipate patient needs. ⋯ Indications for mechanical ventilation in children include marked hypoxia, hypercapnea, peripheral airway obstruction, chest wall deformities, and central nervous system abnormalities. Nurses caring for these children must possess adequate knowledge of the underlying disease process as well as normal respiratory physiology and technical features of ventilators. Nursing strategies can then be directed toward weaning children from the mechanical ventilatory support.