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AACN Advanced Critical Care

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https://read.qxmd.com/read/30523014/tunneled-pleural-catheter-treatment-for-recurrent-pleural-effusion
#1
Chelsea Miller, Elizabeth Bridges, Balaji Laxmanan, Paula Cox-North, Hilaire Thompson
Recurrent pleural effusion is a symptom of several end-stage diseases and is associated with limited life expectancy. Patients with this condition have disabling symptoms resulting in reduced quality of life and often receive inconsistent treatment due to delayed recognition of pleural effusion, repeat procedures, and lengthy hospitalizations. Placement of a tunneled pleural catheter allows the patient to manage his or her symptoms at home, yet this treatment remains underused because of provider misconceptions and unfamiliarity with the intervention...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523013/reducing-tracheostomy-related-pressure-injuries
#2
Lois M Dixon, Susan Mascioli, Jefferson H Mixell, Tom Gillin, Camille N Upchurch, Kevin M Bradley
An interprofessional team was established to prevent tracheostomy-related acquired pressure injuries. The team performed an in-depth analysis of practice from tracheostomy insertion through postinsertion care. A literature evaluation identified best practices, and a root cause analysis for all tracheostomy-related pressure injury cases identified common causes. Lessons learned from the practice and literature reviews drove care standardization and reduced variation. Preimplementation and postimplementation data were analyzed to determine the effectiveness of improvement interventions...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523012/acute-respiratory-distress-syndrome-and-prone-positioning
#3
Dannette A Mitchell, Maureen A Seckel
Acute respiratory distress syndrome continues to have high morbidity and mortality despite more than 50 years of research. The Berlin definition in 2012 established risk stratification based on degree of hypoxemia and the use of positive end-expiratory pressure. The use of prone positioning as a treatment modality has been studied for more than 40 years, with recent studies showing an improvement in oxygenation and decreased mortality. The studies also provide evidence to support the methodology and length of treatment time...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523011/capnography-monitoring-during-procedural-sedation-and-analgesia
#4
John J Gallagher
Procedural sedation is used to alleviate pain and anxiety associated with diagnostic procedures in the acute care setting. Although commonly used, procedural sedation is not without risk. Key to reducing this risk is early identification of risk factors through presedation screening and monitoring during the procedure. Electrocardiogram, respiratory rate, blood pressure, and pulse oximetry commonly are monitored. These parameters do not reliably identify airway and ventilation compromise. Capnography measures exhaled carbon dioxide and provides early identification of airway obstruction and hypoventilation...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523010/alternative-modes-of-mechanical-ventilation
#5
John J Gallagher
Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523009/advances-in-evidence-based-pulmonary-care
#6
Maureen A Seckel
No abstract text is available yet for this article.
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523008/boot-camp-for-caregivers-of-children-with-medically-complex-conditions
#7
Julie Van Orne, Kaylan Branson, Mary Cazzell
BACKGROUND: The safe transition of children with complex medical conditions who are dependent on technology from hospital to home requires that caregivers receive specialized training from qualified health care professionals. Inadequate caregiver training can lead to discharge delays and hospital readmissions, often resulting in caregiver distress. OBJECTIVE: To determine the effectiveness of a structured boot camp-style predischarge training program for caregivers of pediatric patients with complex medical conditions...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30523007/interoperability-of-infusion-pumps-with-electronic-health-records
#8
Linda Harrington
No abstract text is available yet for this article.
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185504/wellens-syndrome
#9
Karen M Marzlin
No abstract text is available yet for this article.
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185500/clinical-presentation-and-treatment-of-amniotic-fluid-embolism
#10
Anne-Marie McBride
Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40‚ÄČ000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185499/pulmonary-edema-in-obstetrics-essential-facts-for-critical-care-nurses
#11
Rebecca L Cypher
Pulmonary edema is an acute pregnancy complication that, if uncorrected, can result in increased maternal and fetal morbidity and mortality. Although pulmonary edema is relatively rare in the general obstetrics population, pregnant patients are at increased risk for pulmonary edema because of the physiologic changes of pregnancy. The risk may be exacerbated by certain pregnancy-related diseases, such as preeclampsia. Prompt identification and appropriate clinical management of pulmonary complications is critical to prevent adverse outcomes in pregnant patients...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185498/preeclampsia-acute-complications-and-management-priorities
#12
Patricia M Witcher
Acute complications of preeclampsia contribute substantially to maternal and fetal morbidity and mortality. The considerable variation in onset, clinical presentation, and severity of this hypertensive disease that is unique to pregnancy creates challenges in identifying risk factors for clinical deterioration. Delivery of the fetus remains the only definitive treatment for preeclampsia. Surveillance of signs and symptoms and laboratory parameters consistent with progression in severity requires an appreciation of the dynamic and progressive nature of the disease...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185497/recognition-and-management-of-sepsis-in-the-obstetric-patient
#13
Sheryl E Parfitt, Sandra L Hering
Sepsis is one of the principal causes of maternal mortality in obstetrics. Physiologic changes that occur during pregnancy create a vulnerable environment, predisposing pregnant patients to the development of sepsis. Furthermore, these changes can mask sepsis indicators normally seen in the nonobstetric population, making it difficult to recognize and treat sepsis in a timely manner. The use of maternal-specific early warning tools for sepsis identification and knowledge of appropriate interventions and their effects on the mother and fetus can help clinicians obtain the best patient outcomes in acute care settings...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185496/cardiac-disease-in-pregnancy
#14
Stephanie Martin, Julie Arafeh
In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185495/evidence-based-strategies-for-maternal-stabilization-and-rescue-in-obstetric-hemorrhage
#15
Carol J Harvey
Obstetric hemorrhage is one of the most frequent causes of maternal death in the United States. More than 70% of maternal deaths from hemorrhage are preventable. State and professional quality care organizations have reduced severe maternal morbidity by more than 20% by implementing evidence-based guidelines. Successful hemorrhage management requires collaborative, multidisciplinary teams of trained health care personnel. Hemorrhage management's primary goal is to stop the bleeding before the occurrence of maternal hypovolemia, acidosis, coagulopathy, and death...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185494/physiologic-and-hemodynamic-changes-during-pregnancy
#16
Nan H Troiano
Substantial physiologic changes accompany pregnancy, the most profound of which involve the cardiovascular system. These changes affect maternal hemodynamic and oxygen transport status. This article describes cardiovascular changes that occur during pregnancy including blood volume, heart rate, stroke volume, cardiac output, vascular resistance, and colloid osmotic pressure. Alterations in factors related to maternal oxygen transport including oxygen affinity, delivery, and consumption also are described. Concepts related to fetal oxygen transport and adaptive responses to hypoxemia are presented...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185492/impact-of-coaching-on-the-nurse-physician-dynamic
#17
Fayyadh R Yusuf, Ambuj Kumar, Wendi Goodson-Celerin, Tracey Lund, Janet Davis, Mary Kutash, Charles N Paidas
BACKGROUND: Limited resources and increased patient care demands have strained nurse-physician relationships in our hospital's neurosurgical intensive care unit, leading to low morale and adversarial dynamics. Studies exploring benefits of coaching interprofessional teamwork demonstrate performance improvements. Therefore, a coaching program designed to improve nurse-physician teamwork was initiated by the neurosurgery department of the hospital's affiliated university. OBJECTIVE: To assess the impact of a coaching program for nurses and physicians on workplace performance in a neurosurgical intensive care unit at a level 1 trauma center...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/30185491/pharmacokinetics-and-extracorporeal-membrane-oxygenation-in-adults-a-literature-review
#18
REVIEW
Monika Tukacs
Extracorporeal membrane oxygenation is a rapidly emerging treatment for respiratory or cardiac failure and is used as a bridge to recovery, transplant, or destination therapy. Adult patients receiving extracorporeal membrane oxygenation also receive significant amounts of pharmacotherapy. Although the body of literature on extra-corporeal membrane oxygenation in general is extensive, only a few publications focus on pharmacokinetic changes related to extracorporeal membrane oxygenation in adults. Understanding pharmacokinetics in adult patients receiving extracorporeal membrane oxygenation is important to correctly select and dose medications in this patient population...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/29875116/evidence-based-review-of-clinical-trials-in-neurocritical-care
#19
Molly McNett, Cristina Moran, Halee Johnson
Neurocritical care is a rapidly growing specialty of complex care for the critically ill patient with neurological injury. This rapid growth has led to an increase in the number of important clinical trials to guide clinical practice and evidence-based care of the critically ill patient with neurological injury. Specialty-trained critical care nurses and advanced practice providers are integral members of neurocritical care teams and must remain informed about pivotal trials shaping practice recommendations...
2018: AACN Advanced Critical Care
https://read.qxmd.com/read/29875115/multimodal-neuromonitoring-in-neurocritical-care
#20
Sarah H Peacock, Amanda D Tomlinson
Neuromonitoring is important for patients with acute brain injury. The bedside neurologic examination is standard for neurologic monitoring; however, a clinical examination may not reliably detect subtle changes in intracranial physiology. Changes found during neurologic examinations are often late signs. The assessment of multiple physiological variables in real time can provide new clinical insights into treatment decisions. No single monitoring modality is ideal for all patients. Simultaneous assessment of cerebral hemodynamics, oxygenation, and metabolism, such as in multimodal monitoring, allows an innovative approach to individualized patient care...
2018: AACN Advanced Critical Care
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