Articles: critical-care.
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Curr. Opin. Pediatr. · Jun 1998
ReviewInhaled nitric oxide in the treatment of hypoxemic respiratory failure.
Inhaled nitric oxide (iNO) is a pulmonary vasodilator that recruits blood flow to well-ventilated lung areas in the presence of lung disease. iNO may improve oxygenation by decreasing intrapulmonary shunt or may worsen oxygenation by reversing hypoxic pulmonary vasoconstriction, therapy increasing ventilation-perfusion mismatch. Recent studies have examined the mechanisms for gas exchange alterations with iNO. ⋯ The potential benefit of iNO therapy must be weighed against the potential risks of inactivating surfactant and platelet function as well as influencing endogenous pulmonary vasoregulation. Well-designed studies will be important to determine whether the improvement in oxygenation outweighs these as well as unknown risks.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1998
Review[Tissue oxygenation: physiological and pathophysiologic aspects in intensive care].
Continuous oxygen supply to the tissues is one of the many important factors in intensive care. However, as a basic requirement for the structure and function of higher developed organisms energy production by oxydative metabolism is of outstanding importance, because there is no significant storage of energy and anaerobic metabolism is insufficient. The determinants of oxygen supply--blood flow and oxygen content--are well known. ⋯ Only when an imbalance between oxygen supply and demand--an oxygen debt--is realized at an early stage, the critically ill patient can be saved from irreversible damage. In the field of intensive care the frequently latent tissue hypoxia is often a result of the chronic oxygen debt of individual, particularly vulnerable organs. Considering those aspects the intestinal mucosa is particularly suited for the monitoring of tissue oxygenation in the critically ill patient.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two methods of securing an endotracheal tube.
While a variety of methods exist for securing an endotracheal tube (ETT), there has been little research on their safety and efficacy. This study aimed to test the equivalence of two methods in three critical care settings by randomly assigning patients to receive either the knot, which requires scissors or blade to remove the ETT tape, or the bow, which can be removed manually. These methods were evaluated by comparing ETT movement, malposition, dislodgement, inadvertent extubation, reduced skin integrity, the cutting of the pilot tube and nurse satisfaction. ⋯ Nurses found that patient mouth care was easier and patient comfort and skin integrity enhanced with the bow method. On the other hand, nurses perceived the knot-tying method to be more secure and easier to apply. Given the equivalence of the two methods, the bow would seem preferable for reasons of safety and comfort.
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J N Y State Nurses Assoc · Jun 1998
ReviewPain management at the end of life: a critical care perspective.
The nationwide public push for sweeping changes in the care of the dying has highlighted dissatisfaction with the way end-of-life care is provided in critical care units. This paper addresses barriers to improving that care, and suggests assessments and strategies that nurses could use to improve quality in this important area.