Articles: critical-care.
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A review of rural-based critical care nursing has demonstrated that quality critical care can be delivered within the constraints of rural practice. The barriers most often found affecting rural care have been described. ⋯ The rural nurse manager has the opportunity to create a critical care nursing service with high levels of accountability, that can quickly respond to change, and that produces quality patient care. By accomplishing these goals, rural critical care nurses will leave a meaningful legacy of enhanced lives and improved health for their rural communities.
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Comparative Study
Response of critically ill patients to treatment aimed at achieving supranormal oxygen delivery and consumption. Relationship to outcome.
To evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport variables (cardiac index [CI] > 4.5 L/min/m2, oxygen delivery [DO2] > 600 ml/min/m2, and oxygen consumption [VO2] > 170 ml/min/m2) in a heterogenous group of critically ill patients and to assess its relationship to outcome. ⋯ These results suggest that failure to increase VO2 was related predominantly to an inability of the tissues to extract or utilize oxygen rather than a failure to increase DO2. These findings support the hypothesis that in order to survive a critical illness, patients must achieve a high level of VO2. An inability to do so is reflected in persistently elevated blood lactate levels and an extremely poor prognosis.
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Critical care medicine · Feb 1993
High-frequency oscillatory ventilation in pediatric respiratory failure.
To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to achieve and maintain optimal lung volume in pediatric patients with respiratory failure. ⋯ High-frequency oscillatory ventilation, using a high-volume strategy, may be used safely and effectively in pediatric patients with respiratory failure and with high predicted mortality rates. High mean airway pressure during oscillatory ventilation does not appear to compromise DO2. Whether this technique can alter morbidity or mortality rates in this population awaits prospective randomized study.