scholarly journals Letting the Patient Decide: A Case Report of Self-Administered Sedation During Mechanical Ventilation

2018 ◽  
Vol 38 (1) ◽  
pp. 17-23
Author(s):  
Breanna Hetland ◽  
Sarah Maryon Hayes ◽  
Debra Skaar ◽  
Mary Fran Tracy ◽  
Craig R. Weinert ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Case Report ◽  
Study Protocol ◽  
Pilot Trial ◽  
Critical Care Nurses ◽  
Self Management ◽  
Use Of Self ◽  
Patient Controlled Analgesia ◽  
Ventilator Support

It is common for critical care nurses to administer sedative medications to patients receiving mechanical ventilation. Although patient-controlled analgesia is frequently used in practice to promote effective self-management of pain by patients, it is not known if patient-controlled sedation can be used to promote effective self-management of distressing symptoms associated with mechanical ventilation. A randomized pilot trial was conducted to evaluate whether patient self-administered sedation with dexmedetomidine is safe and acceptable for self-management of anxiety during ventilator support. This case report details the experiences of one patient enrolled in the pilot trial who was randomly assigned to the experimental dexmedetomidine intervention, completed the study protocol, and provided feedback. In a poststudy survey, the patient responded positively to the use of self-administered sedation with dexmedetomidine during ventilator support.

Diagnosis of chronic post-hypoxic myoclonus in near hanging survivor: Case report

2020 ◽  
Vol 32 (1) ◽  
pp. 5-8
Author(s):  
David Hersey
Keyword(s):  
Critical Care ◽  
Case Report ◽  
Cognitive Function ◽  
Attempted Suicide ◽  
Late Onset ◽  
Respiratory Arrest ◽  
Critical Care Nurses ◽  
Impaired Cognitive Function ◽  
Rare Syndrome

A 39-year-old male, who attempted suicide by hanging, developed chronic myoclonus with intact cognitive function. Chronic post-hypoxic myoclonus is a rare syndrome that may develop after a respiratory arrest and it presents as late onset and persistent purposeful myoclonus with preserved or slightly impaired cognitive function. Increasing critical care nurses’ awareness of chronic post-hypoxic myoclonus will lead to earlier diagnosis of this rare syndrome.

Physicians’ Estimates of Cardiac Index and Intravascular Volume Based on Clinical Assessment Versus Transesophageal Doppler Measurements Obtained by Critical Care Nurses

2003 ◽  
Vol 12 (4) ◽  
pp. 336-342 ◽  
Author(s):  
Manuel G. Iregui ◽  
Donna Prentice ◽  
Glenda Sherman ◽  
Lynn Schallom ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Critical Care ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Critical Care Nurses ◽  
Doppler Imaging ◽  
Intravascular Volume ◽  
Pulmonary Artery Catheterization ◽  
Transesophageal Doppler

• Objectives To compare physicians’ estimates of cardiac index and intravascular volume with transesophageal Doppler measurements obtained by critical care nurses, to assess the overall safety of transesophageal Doppler imaging by critical care nurses, and to compare hemodynamic measurements obtained via transesophageal Doppler imaging with those obtained via pulmonary artery catheterization. • Methods Data were collected prospectively on 106 patients receiving mechanical ventilation. Physicians estimated cardiac index and intravascular volume status by using bedside clinical assessment; critical care nurses, by using transesophageal Doppler imaging. In 24 patients, Doppler measurements were obtained within 6 hours of placement of a pulmonary artery catheter and recording of cardiac output and pulmonary artery occlusion pressure. • Results With Doppler measurements as the reference, physicians correctly estimated cardiac index in 46 (43.8%) of 105 patients, underestimated it in 24 (22.9%), and overestimated it in 35 (33.3%). They correctly estimated volume status in 31 patients (29.5%), underestimated it in 16 (15.2%), and overestimated it in 58 (55.2%). Doppler measurements of cardiac output correlated with those obtained via pulmonary artery catheterization (r = 0.778; P < .001). Two patients had minor complications: dislodgement of a nasogastric tube and inability to obtain a Doppler signal. • Conclusion Physicians’ assessment of cardiac index and intravascular volume in patients receiving mechanical ventilation is correct less than half of the time. Transesophageal Doppler imaging by critical care nurses appears to be a safe method for measuring cardiac index and estimating intravascular volume. Measurements obtained via Doppler imaging correlate well with those obtained via pulmonary artery catheterization.

Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

2007 ◽  
Vol 16 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Louise Rose ◽  
Sioban Nelson ◽  
Linda Johnston ◽  
Jeffrey J. Presneill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Intensive Care ◽  
Interdisciplinary Collaboration ◽  
Multiple Organ ◽  
Critical Care Nurses ◽  
Royal Melbourne Hospital ◽  
Adult Intensive Care Unit ◽  
Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation

2012 ◽  
Vol 27 (6) ◽  
pp. 549-555 ◽  
Author(s):  
Jae Hyung Roh ◽  
Ara Synn ◽  
Chae-Man Lim ◽  
Hee Jung Suh ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Critical Care Nurses

AACN Synergy Model’s Characteristics of Patients: Psychometric Analyses in a Tertiary Care Health System

2007 ◽  
Vol 16 (2) ◽  
pp. 158-167 ◽  
Author(s):  
Barbara B. Brewer ◽  
Anne W. Wojner-Alexandrov ◽  
Nora Triola ◽  
Christine Pacini ◽  
Melanie Cline ◽  
...  
Keyword(s):  
Critical Care ◽  
Case Report ◽  
Construct Validity ◽  
Patient Care ◽  
Internal Consistency ◽  
Internal Consistency Reliability ◽  
Critical Care Nurses ◽  
Case Report Form ◽  
Second Phase ◽  
Interaction Factor

• Background Models for delivery of patient care that recognize the relationship between the characteristics of the patient and the competencies of the nurse are essential for high-quality outcomes.• Objectives (1) To test application of a case report form used to assess patients’ characteristics as defined by the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care in a general population of pediatric and adult patients and (2) to evaluate the internal consistency reliability and construct validity of the patient characteristics measure found on the American Association of Critical-Care Nurses Web site.• Methods A cross-sectional correlational study was conducted in 2 phases. The first phase consisted of secondary data analysis of 481 ratings of patients provided by 11 expert nurses. The second phase consisted of primary data collection of 279 ratings of patients provided by 116 general and critical care nurses. The case report form was used to rate characteristics of patients in both phases; a self-rated nursing proficiency scale was used in the second phase. Descriptive statistics were used to describe the sample. Correlational techniques were used to evaluate internal consistency reliability and evidence of construct validity.• Results The case report form based on the AACN Synergy Model’s characteristics of patients showed satisfactory internal consistency reliability and evidence of discriminant construct validity. Exploratory factor analysis resulted in a 2-factor solution representing an intrapersonal interaction factor and an interpersonal interaction factor.• Conclusion The case report form for assessing characteristics of patients showed utility in a general population of adult and pediatric patients, some critically ill and some not. Nurses without previous knowledge of the AACN Synergy Model were able to apply the model during routine patient care.

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