Articles: critical-care.
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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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Approximately 2 million people die in the United States each year, 80% of them in acute- or chronic-care institutions. Physicians now have at their disposal interventions that can postpone death in almost every instance. ⋯ On the other hand, the fact that medical resources are becoming increasingly expensive and scarce will inevitably lead to rationing. The critical-care physician will be caught in the middle--orchestrating clinical care to balance the interests of individual patients and families against those of the larger community.
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The status of conventional monitoring by vital signs and present concepts of invasive monitoring with the balloon-tipped pulmonary artery (Swan-Ganz) catheter are reviewed. Survivors of high-risk general surgery were observed to have cardiac index (CI) values averaging 4.5 L/min.m2, oxygen delivery (DO2) greater than 600 mL/min.m2, and oxygen consumption (VO2) greater than 170 mL/min.m2. By contrast, those who subsequently died during their hospitalization maintained relatively normal CI, DO2, and VO2 values. ⋯ Two-thirds recovered with increased cardiac function, more than one-half had improved perfusion, and paO2 increased in fewer than one-fifth of monitored events. These data provide an information base for criteria needed to develop therapeutic decision rules for noninvasive monitoring systems. When noninvasive data are continuously displayed early in the course of critical illness and high-risk conditions, therapy may be instituted early, while physiological deficits are still minimal and easily reversible.
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This short review will address the potential uses for quantitative analyses of organ function in the critically ill patient. Multiple system failure is common in the critical-care unit, and the ability to measure reserves of organ function may enable earlier detection and treatment of this problem and provide a more accurate prognosis for such patients.