Articles: intensive-care-units.
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OBJECTIVE--To determine the frequency of deep venous thrombosis (DVT) in medical intensive care unit (MICU) patients. DESIGN--Prospective ultrasound case series. SETTING--An MICU in a large tertiary care hospital in Boston, Mass. ⋯ CONCLUSIONS--An unexpectedly high rate of DVT was detected by ultrasound in these MICU patients despite prophylaxis in 61%. Traditionally recognized DVT risk factors failed to identify patients who developed DVT. Routine ultrasound surveillance or more intensive prophylaxis regimens may be warranted in this patient population if these DVT rates are confirmed in other settings.
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Maximizing healing in the ICU environment requires active promotion of sleep as a nursing intervention. Changing practice requires a two-pronged approach: developing an expanded knowledge base related to the physiological effects of sleep and especially healing, and minimizing the impact of the traditional ICU system on sleep deprivation.
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When a patient is admitted to the ICU, determine whether the person has decisional capacity and whether an advance directive exists. If so, discuss treatment options and the directive with the patient--as well as with family members and appointed surrogates; clarify the patient's wishes. ⋯ If it does, follow its instructions. If no directive exists or if it does not apply, consult with family members to determine the patient's wishes, and ascertain whether these substitute judgments meet state laws.
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Comparative Study
Cost implications of using inhaled nitric oxide compared with epoprostenol for pulmonary hypertension.
To compare the cost of using intravenous epoprostenol with that of inhaled nitric oxide (NO) for treating episodes of pulmonary hypertension in children with congenital heart disease. ⋯ Using inhaled NO in our pediatric cardiac intensive care unit abolished the use of epoprostenol during the reported monitoring period. The cost savings were significant, amounting to 12% of the annual drug budget for the unit. The cost of setting up the inhaled NO delivery system is recouped rapidly. The ease of delivery and measurement of inhaled NO also may have contributed to its increased clinical use.