Articles: critical-care.
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Effects of a lateral turn on mixed venous oxygen saturation and heart rate in critically ill adults.
The purpose of this study was to determine the effects of a lateral turn on mixed venous oxygen saturation (SvO2) and heart rate in 183 critically ill adults. Mean SvO2 decreased from a baseline of 67% to 61% saturation (p less than 0.0001) immediately after turning and gradually returned to 66% saturation (p less than 0.002) within 4 minutes. Mean heart rate increased slightly from a baseline of 99 beats/min to 102 beats/min (p less than 0.0001) immediately after turning and decreased slightly to 101 beats/min (p less than 0.0004) within 4 minutes. ⋯ Nurses should expect critically ill patients to have a decrease in SvO2 of approximately 9% of baseline and small changes in heart rate after turning. These changes should be transient, with SvO2 and heart rate gradually returning toward baseline levels during the next 4 minutes. If turning triggers large or prolonged changes in SvO2 or heart rate, prompt repositioning and evaluation are needed to prevent adverse effects.
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Critically ill patients often have conditions that reduce oxygen delivery and increase oxygen demand. Routine nursing care, such as suctioning, positioning, and bathing, also increases the patient's oxygen demand. If the patient's oxygen demand exceeds the supply, dysrhythmias, hypotension, altered level of consciousness, and other adverse responses can occur. ⋯ The physiology of oxygen transport is reviewed, and oxygen delivery, reserve, and consumption are defined. Conditions that decrease oxygen delivery and increase oxygen demand are discussed, and the effects on SvO2 are illustrated. With continuous SvO2 monitoring, critical care nurses can see the effect of their nursing care on the patient's oxygenation and can adjust their care according to the patient's tolerance.
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Critical care medicine · Sep 1990
Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients.
We examined the cardiovascular and metabolic response to RBC transfusion in patients with circulatory shock after volume resuscitation. Data were analyzed from 36 transfusions in 32 patients who were undergoing continuous hemodynamic monitoring. Transfusions were administered for moderate to severe anemia, mean Hgb 8.3 g/dl. ⋯ An increase occurred in myocardial work indices and MAP x HR. No changes were identified when subgroups were analyzed based on diagnosis, pretransfusion Hgb, lactate, or VO2 levels. We conclude that selective increase in DO2 by augmentation of RBC mass and oxygen-carrying capacity did not improve the shock state in these volume-resuscitated patients, regardless of the etiology of the shock.
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A small but significant percentage of ICU patients are designated DNR at some time during their ICU stay. DNR patients in the ICU are more ill, use more resources (including nursing care) and have a higher mortality rate than non-DNR patients. In an age of a critical care nursing shortage, spiraling health costs, and an emphasis on the just allocation and use of scarce resources, the question whether DNR patients should be excluded from the ICU is appropriately raised. ⋯ In this authors' opinion, beyond point Z, only palliative treatment is justified in the ICU. DNR patients beyond point Z should not receive curative treatments in the ICU. Many DNR patients fitting this description remain in ICUs, however, perhaps because of physician reluctance to withdraw or withhold life-sustaining treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
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Over the past several years, there has been growth in the number of training programs in the new subspecialty of critical care medicine. The adoption of subspecialty certifying examinations in critical care medicine has added momentum to the growth of the subspecialty. A personal experience in a critical care medicine fellowship training program is detailed and contrasted with a year of clinical pulmonary fellowship training. ⋯ Technical expertise in intensive care unit procedures and therapy was stressed during the critical care medicine fellowship, whereas the year of clinical pulmonary training was of greater scope, encompassing comprehension of pulmonary pathophysiology, diagnostic procedures, and therapy. "Hands-on" intensive care unit training was limited during the pulmonary fellowship, though didactic instruction and the conceptual approach to critical illness was stronger. Research training opportunities were largely equivalent. From this experience, I present suggestions for selecting fellowship training in critical care medicine.