AACN clinical issues in critical care nursing最新文献

{"title":"Anti-inflammatory agents other than corticosteroid in SARs-CoV-2 pneumonia","authors":"P. Theerawit","doi":"10.54205/ccc.v29i.252686","DOIUrl":"https://doi.org/10.54205/ccc.v29i.252686","url":null,"abstract":"The SARs-CoV-2 results in hyperinflammation among infected patients. This condition leads to serious organ injury, especially in the lungs. Therefore, the main treatment option, in addition to anti-viral agents, is the administration of corticosteroids. However, in many cases, inadequate response to corticosteroids has been observed—other anti-inflammatory agents, such as interleukin-6 inhibitor, kinase inhibitor, etc., play an essential role in reducing this severe complication.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78631199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiologic Cardiovascular Studies in Resuscitated Normotensive Septic Shock with Persistent Hyperlactatemia.","authors":"Dujrath Somboonviboon, Waraporn Tiyanon, P. Wacharasint","doi":"10.21203/RS.3.RS-692720/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-692720/V1","url":null,"abstract":"\u0000 Background: To study effects of increasing vasopressor dosage and fluid resuscitation on ventriculoarterial (VA) coupling and venous return (VR)-related parameters in resuscitated normotensive septic shock patients with persistent hyperlactatemia. Methods: We performed a prospective experimental study in patients with septic shock who was admitted to medical intensive care unit and still had hyperlactatemia even received initial resuscitation to maintain mean arterial pressure (MAP) >65 mmHg. All patients received incremental dose of norepinephrine (NE) to increased MAP, then NE was titrated to baseline dosage and waited for 15 mins, then fluid bolus was given. VA coupling-related parameters [arterial elastance (Ea), left ventricular end-systolic elastance (Ees), left ventricular stroke work (SW), potential energy (PE), stroke volume (SV), and Ea/Ees], and VR-related parameters [central venous pressure (CVP), mean systemic pressure analogue (Pmsa), venous return pressure (Pvr)] were measured at 4 time points including pre-increased NE phase, post-increased NE phase, pre-fluid bolus phase, and post-fluid bolus phase. Primary outcome was average of Ea/Ees. Secondary outcomes were differences in VA coupling-related parameters and VR-related parameters between pre- vs. post- interventions.Results: All 20 patients were normotensive [MAP 74 (66-80) mmHg] with elevated blood lactate [2.7 (2.4-3.6) mmol/L] at enrollment. Average Ea/Ees was 0.89 (0.61-1.16). Compared to pre-increased NE phase, post-increased NE phase had significantly higher MAP, CVP, SV, SW, PE, Pmsa, and Pvr. Likewise, compared to pre-fluid bolus phase, post-fluid bolus raised MAP, CVP, SV, Ees, SW, Pmsa, and Pvr significantly. No difference in Ea/Ees compared between before- vs. after- received both interventions.Conclusions: In resuscitated normotensive septic shock patients with persistent hyperlactatemia, we found an average Ea/Ees of 0.89. Increasing NE dosage or fluid bolus increased most of VA coupling-related parameters and VR-related parameters, but not Ea/Ees. Further large study is warranted to validate these findings.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89560697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Mean Systemic Pressure in Patients with Acute Circulatory Failure Receiving Passive Leg Raising vs. Pneumatic Leg Compression.","authors":"Panu Boontoterm, P. Wacharasint, P. Fuengfoo","doi":"10.21203/rs.3.rs-642363/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-642363/v1","url":null,"abstract":"\u0000 Background: Driving pressure of venous return (VR) is determined by mean systemic pressure (Pms) and central venous pressure (CVP). While passive leg raising (PLR) and pneumatic leg compression PC (PC) can increase VR, there is no study explore the effects of these two procedures on Pms and VR-related hemodynamic variables.Methods: Forty patients with acute circulatory failure were included in this analysis. All patients were performed both PLR and PC, and were measured for Pms, CVP, mean arterial pressure (MAP), cardiac output (CO), VR resistance (RVR), and systemic vascular resistance (SVR) at baseline and immediately after procedures. To minimized carry-on effect, the patients were divided into 2 groups based on procedure sequence which were 1) the patients who received PLR first then PC (PLR-first), and 2) the patients who received PC first then PLR (PC-first). Both groups were waited for washing period before performed 2nd procedure. Primary outcome was difference in Pms between PLR and PC procedure. Secondary outcome were differences in CVP, MAP, CO, RVR, and SVR between PLR and PC procedure.Results: There was no difference in baseline characteristics and no carry-on effect between 2 groups of patients. Compared to baseline, both PLR and PC significantly increased Pms, CVP, MAP, and CO. Compared to PC, PLR more increased Pms (9.0±2.3 vs 4.8±1.7 mmHg, p<0.001), CVP (4.5±1.2 vs. 1.6±0.7 mmHg, p<0.001), MAP (22.5±5.6 vs. 14.4±5.0 mmHg, p<0.001), and CO (1.5±0.5 vs. 0.5±0.2 L/min, p<0.001). PC, but not PLR also significantly increased RVR (16 ± 27.2 dyn.s/cm5, p=0.001) and SVR (78.4 ± 7.2 dyn.s/cm5, p<0.001) .Conclusion: In patients with acute circulatory failure, PLR more increased Pms, CVP, MAP, and CO than PC.","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"879 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72433422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of disease-specific formulas.","authors":"G Zaloga,&nbsp;M H Ackerman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Critical illness frequently leads to organ dysfunction. Nutritional support of individual organ function is an evolving area of nutritional support. Within the past several years, there was an increase in the number of nutritional products reported to improve organ function. In this article, the authors review disease/organ-specific nutritional support, including the theory behind therapy and the empiric data supporting or refuting these theories. It is hoped that this article will aid practitioners in their nutritional management of patients with organ dysfunction.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"421-35; quiz 536-8"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional support strategies: a case study approach.","authors":"P J Posa","doi":"10.1097/00044067-199405040-00003","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00003","url":null,"abstract":"<p><p>Malnutrition in critically ill patients is caused by inadequate intake, absorption, and/or utilization of nutrients with a frequently compounding increased metabolic need. The nurse plays a pivotal role in the identification of patients at risk for nutritional deficits and collaborates with appropriate resources to obtain a comprehensive nutritional assessment and the required nutritional care. A five-step approach to nutritional support is presented and applied to three clinical situations. Through the use of a systematic decision-making process, the critical care practitioner ensures that patients receive adequate nutritional support for optimal organ function.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"436-42"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional management during critical illness in infants and children.","authors":"M K Norris,&nbsp;D M Steinhorn","doi":"10.1097/00044067-199405040-00008","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00008","url":null,"abstract":"<p><p>Nutritional needs and management of critically ill infants and children are complex and fundamentally different from adults. In addition to common physiologic issues of nutrition during acute illnesses, infants and children have nutritional needs related to growth and development of the whole child as well as individual organ systems. Critical care nurses play a key role in assuring that both physiologic and developmental needs related to nutrition are met, to prevent long-term complications.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"485-92; quiz 539-41"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol-related end-stage liver disease and transplantation: the debate continues.","authors":"L A Kelso","doi":"10.1097/00044067-199405040-00011","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00011","url":null,"abstract":"<p><p>Liver transplantation has been an acceptable treatment for end-stage liver disease for many years. The greatest number of patients needing transplantation for survival are those suffering from alcohol-related end-stage liver disease. Throughout the years, many debates and much research have been completed looking at the medical and ethical responsibility to give transplants to these patients. In this article, the author looks at some of the arguments facing transplantation in patients with alcoholism and some of the related research published.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"501-6"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of total parenteral nutrition in critical illness: guidelines and recommendations.","authors":"N J Evans","doi":"10.1097/00044067-199405040-00007","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00007","url":null,"abstract":"<p><p>Critically ill patients experience a multitude of metabolic derangements in response to sepsis, shock, and severe injury. The result of extreme stress is characterized by alterations in carbohydrate and fat metabolism and persistent catabolism of lean body mass. Total parenteral nutrition is an important therapeutic modality in the care of critically ill patients. In this article, the author identifies the patient at risk, defines the appropriate time to initiate parenteral nutrition, and outlines current recommendations for energy and protein prescription. The author also briefly reviews administration issues, discusses possible complications of therapy, and defines effective strategies to monitor the response to therapy.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"476-84"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Terminal weaning from mechanical ventilation: a review.","authors":"M E Shekleton,&nbsp;S M Burns,&nbsp;J M Clochesy,&nbsp;S K Hanneman,&nbsp;G L Ingersoll,&nbsp;A R Knebel","doi":"10.1097/00044067-199405040-00014","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00014","url":null,"abstract":"<p><p>Terminal weaning is a clinical intervention for withdrawing mechanical ventilatory support when such support is an unacceptable outcome for a patient. Withdrawal of life support must be done in a humane manner for the patient, the family, and the patient's care providers. Research-based directions for clinical practice are limited because of the paucity of research in this area. Recommendations for future study are related to methods, facilitative therapy, patient, family, and caregiver responses, and care delivery models.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"523-33"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18743309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The stigmatized patient with AIDS in the intensive care unit: the role of the advanced practice nurse.","authors":"L Mosier","doi":"10.1097/00044067-199405040-00010","DOIUrl":"https://doi.org/10.1097/00044067-199405040-00010","url":null,"abstract":"<p><p>As the incidence of HIV infection rises, so will cases of HIV positive intensive care unit admissions. Factors affecting nurses' care of these patients include fear of contagion, homophobia, and lack of knowledge. A multidimensional approach must be taken by the advanced practice nurse to decrease stigmatization by changing knowledge and attitudes of intensive care unit nurses.</p>","PeriodicalId":76963,"journal":{"name":"AACN clinical issues in critical care nursing","volume":"5 4","pages":"495-500"},"PeriodicalIF":0.0,"publicationDate":"1994-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00044067-199405040-00010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18742756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}