Critical care nurse最新文献_第10页

Using a Fluid Resuscitation Algorithm to Reduce the Incidence of Abdominal Compartment Syndrome in the Burn Intensive Care Unit. 应用液体复苏算法降低烧伤重症监护病房腹膜隔室综合征的发生率。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023162

Jasmine Peters, Paul Won, Julie Herrera, T Justin Gillenwater, Haig A Yenikomshian

{"title":"Using a Fluid Resuscitation Algorithm to Reduce the Incidence of Abdominal Compartment Syndrome in the Burn Intensive Care Unit.","authors":"Jasmine Peters, Paul Won, Julie Herrera, T Justin Gillenwater, Haig A Yenikomshian","doi":"10.4037/ccn2023162","DOIUrl":"10.4037/ccn2023162","url":null,"abstract":"Background: Patients with large burns must be carefully resuscitated to balance adequate tissue perfusion with the risk of end-organ damage. One devastating complication of overresuscitation is abdominal compartment syndrome. Reducing the volume of fluids given during resuscitation may reduce the incidence of abdominal compartment syndrome and improve outcomes.Objective: To determine whether decreasing fluid resuscitation volume in a burn center reduced the incidence of abdominal compartment syndrome.Methods: This retrospective cohort study involved all patients with severe burns (total body surface area ≥20%) who were admitted to a burn intensive care unit over 4 years (n = 166). Primary outcomes were required fluid volume, whether differences in the patient characteristics measured affected outcomes, rate of abdominal compartment syndrome, and incidence of abdominal hypertension. After the first 2 years, the Parkland fluid resuscitation algorithm was modified to decrease the volume goal, and patients were assessed for the incidence of abdominal compartment syndrome and related complications such as kidney failure, abdominal hypertension, and ventilator days.Results: A total of 16% of patients resuscitated using the Parkland equation experienced abdominal compartment syndrome compared with 10% of patients resuscitated using the modified algorithm, a difference of 6 percentage points (P = .39). Average volume administered was 11.8 L using the Parkland formula and 9.4 L using the modified algorithm (P = .03).Conclusion: Despite a significant decrease in the amount of fluid administered, no significant difference was found in incidence of abdominal compartment syndrome or urine output. Matched prospective studies are needed to improve resuscitation care for patients with large burns.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"43 6","pages":"58-66"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Historical Letters to the Editor Mirror Current Issues in Nursing. 给编辑的历史信件反映了护理中的当前问题。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023950

Annette M Bourgault

引用次数: 0

Nursing Management of a Patient With Fulminant Myocarditis and Electrical Storm Receiving ECMO: A Case Report. 暴发性心肌炎合并电风暴患者行ECMO的护理管理1例报告。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023112

Xiaoxiao Wu, Xiaoyan Wang, Jinmei Luo, Fang Tian, Jin Bian

{"title":"Nursing Management of a Patient With Fulminant Myocarditis and Electrical Storm Receiving ECMO: A Case Report.","authors":"Xiaoxiao Wu, Xiaoyan Wang, Jinmei Luo, Fang Tian, Jin Bian","doi":"10.4037/ccn2023112","DOIUrl":"10.4037/ccn2023112","url":null,"abstract":"Introduction: Fulminant myocarditis is a devastating disease with significant mortality and complications. The care of patients with fulminant myocarditis is rarely reported.Clinical findings: A 17-year-old female patient was admitted to the emergency department with dizziness, amaurosis fugax, and chest tightness. Initial assessment revealed elevated levels of troponin T (4.753 ng/mL), troponin I (49.540 ng/mL), creatine kinase (1306 U/L), creatine kinase-MB isoenzymes (75.71 ng/mL), lactate dehydrogenase (509 U/L), and N-terminal pro-B-type natriuretic peptide (6345 pg/mL). The patient had recurrent ventricular tachycardia and failed to maintain a sinus rhythm after multiple electrical cardioversions.Diagnosis: Echocardiography revealed a left ventricular ejection fraction of 34%. Magnetic resonance imaging results confirmed the diagnosis of myocarditis.Interventions: The patient received extracorporeal membrane oxygenation for 6 days, intra-aortic balloon pump support for 7 days, and mechanical ventilation for 5 days. Norepinephrine and dopamine were used to keep circulation stable, lidocaine and amiodarone were used to control heart rate, and glucocorticoids and immunoglobulins were used to modulate immunity.Outcomes: The patient was discharged after 23 days. A month after discharge, echocardiography showed that the ejection fraction was 60%. The patient reported complete resolution of signs and symptoms of fulminant myocarditis at follow-up assessment.Conclusion: This case report presents the activities of bedside nurses in caring for a patient with fulminant myocarditis and broadens the literature describing nursing interventions for patients with fulminant myocarditis.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"43 6","pages":"22-33"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using Remote Technology in Patient Care. 在病人护理中使用远程技术。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023741

Lisa-Mae Williams

引用次数: 0

Prone Positioning in Patients With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome. COVID-19和非COVID-19急性呼吸窘迫综合征患者的俯卧位

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023807

Albert J Shin, Dong Sung An, Nancy Jo Bush

{"title":"Prone Positioning in Patients With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome.","authors":"Albert J Shin, Dong Sung An, Nancy Jo Bush","doi":"10.4037/ccn2023807","DOIUrl":"10.4037/ccn2023807","url":null,"abstract":"Background: Patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) and may undergo prone positioning.Objective: To compare the effects of prone positioning on oxygenation, intensive care unit length of stay, and intubation days in patients with COVID-19 ARDS and patients with non-COVID-19 ARDS.Methods: A convenience sample of intubated patients with COVID-19 and moderate to severe ARDS (per Berlin criteria) was compared with historical data from a retrospective, descriptive medical record review of patients with non-COVID-19 ARDS. The historical comparison group was age and sex matched.Results: Differences in Po2 to fraction of inspired oxygen ratios between the COVID-19 ARDS group (n = 41) and the non-COVID-19 ARDS group (n = 6) during the first 7 days of prone positioning were significant at the end of prone positioning on day 1 (P = .01), day 3 (P = .04), and day 4 (P = .04). Wilcoxon signed-rank tests showed that prone positioning had a positive impact on Po2 to fraction of inspired oxygen ratios from day 1 through day 6 in the COVID-19 ARDS group and on day 2 in the non-COVID-19 ARDS group.Conclusion: This retrospective review found greater improvement in oxygenation in the COVID-19 ARDS group than in the non-COVID-19 ARDS group. This finding may be attributed to the assertive prone positioning protocol during the pandemic and teams whose skills and training were likely enhanced by the pandemic demand. Prone positioning did not affect intensive care unit length of stay or intubation days in either group.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"43 6","pages":"34-46"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial Intelligence and the Critical Care Nurse 人工智能与重症监护护士

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023515

引用次数: 0

Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration. 使用数字漏气检测装置减少胸管时间。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-12-01 DOI: 10.4037/ccn2023951

Carla Patel, Susan D Ruppert, Hue Cao, Cheryl Fraser, TaCharra Laury, Ara Vaporciyan

{"title":"Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration.","authors":"Carla Patel, Susan D Ruppert, Hue Cao, Cheryl Fraser, TaCharra Laury, Ara Vaporciyan","doi":"10.4037/ccn2023951","DOIUrl":"10.4037/ccn2023951","url":null,"abstract":"Background: The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit.Implementation: Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years).Evaluation: Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P = .01 and P = .004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm.Conclusions: Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"43 6","pages":"11-21"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sleep in the Critical Care Setting. 在重症监护环境中睡眠。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-10-01 DOI: 10.4037/ccn2023592

Michelle J Kidd

引用次数: 0

Own It! 拥有它!

4区医学

Critical care nurse Pub Date : 2023-10-01 DOI: 10.4037/ccn2023239

{"title":"Own It!","authors":"","doi":"10.4037/ccn2023239","DOIUrl":"https://doi.org/10.4037/ccn2023239","url":null,"abstract":"Practice Pointers| October 01 2023 Own It! Crit Care Nurse (2023) 43 (5): 68. https://doi.org/10.4037/ccn2023239 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Cite Icon Cite Get Permissions Citation Own It!. Crit Care Nurse 1 October 2023; 43 (5): 68. doi: https://doi.org/10.4037/ccn2023239 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentCritical Care Nurse Search Advanced Search Inconsistent leadership in the cardiovascular intensive care unit (CVICU) at Methodist Hospital in San Antonio, Texas, contributed to increased turnover in staff nurses and decreased physician satisfaction. To help resolve this problem, the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) team in the CVICU implemented the “Own It!” project. First, the CSI team collected baseline data using the HWEAT. Then the project was officially announced to the nurses in the CVICU unit. The strategy of the project involved the following: Near the end of the project, the CSI team surveyed the staff using the HWEAT. Results indicated that the team exceeded their improvement goals, with a larger than expected reduction in their unit’s staff nurse turnover rate. Overall the project was an amazing success, and the CSI team hopes to conduct the project in other intensive care units in their organization. Sueyon Dodd, BSN, RN, Kevin Muntean,... You do not currently have access to this content.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"149 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135368952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms. 利用远程中风改善有中风症状的农村患者获得护理的机会。

IF 1.6 4区医学

Critical care nurse Pub Date : 2023-10-01 DOI: 10.4037/ccn2023505

Lori Hendrickx, Chelsey Kuznia, Lindsey Maneval

{"title":"Use of Telestroke to Improve Access to Care for Rural Patients With Stroke Symptoms.","authors":"Lori Hendrickx, Chelsey Kuznia, Lindsey Maneval","doi":"10.4037/ccn2023505","DOIUrl":"10.4037/ccn2023505","url":null,"abstract":"Background: Cerebrovascular accident, or stroke, is a common cause of death or disability. Timely diagnosis and intervention are critical for improving survival rates and reducing the long-term effects of stroke. For patients with ischemic stroke, thrombolytic drugs and endovascular intervention are time-sensitive treatment options.Local problem: Patients living in rural areas often do not have access to rapid consultation with specialized neurologic teams for diagnosis and treatment of stroke. The use of telemedicine in the form of a telestroke consultation can improve timely diagnosis and treatment for rural patients exhibiting stroke symptoms.Methods: A telestroke program was implemented in the upper Midwest. A team of 4 interventional neurologists provided telestroke consultation to a comprehensive stroke center and 5 other acute stroke-ready rural hospitals.Results: A tiered stroke alert algorithm and telestroke workflow chart were developed to help health care professionals at rural sites determine eligibility for telestroke consultation. A teleneurologist connected with the originating site, and the National Institutes of Health Stroke Scale could be completed remotely with assistance from the originating site. Telestroke has increased the percentage of patients receiving thrombolytics in less than 60 minutes, and door-to-needle time has decreased.Conclusion: Rural patients with stroke symptoms may experience a delay in care or stroke diagnosis due to distance to specialized neurologic services. Telestroke consultation is a successful method for timely diagnosis of stroke and recommendation for treatment.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"43 5","pages":"49-56"},"PeriodicalIF":1.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41117985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0