Home About us Contact
|
Home About us Contact | ||
|
|
||
Ill Adult Patients (ill + adult_patient)
Selected AbstractsEffectiveness of the auscultatory and pH methods in predicting feeding tube placementJOURNAL OF CLINICAL NURSING, Issue 11-12 2010e San Turgay Aims and objectives., This study was designed to determine the effectiveness of the auscultatory and pH methods in predicting feeding tube location in critically ill patients. Background., There is confusion about how nurses should asses feeding tubes location at the bedside. The most common method for determining tube location is the auscultatory method. It is known that auscultation is an unreliable method and additional data relating to bedside methods are needed to assist nurses in making a decision regarding tube location. Design., A methodological study. Methods., The sample consisted of 44 new insertions of feeding tubes. Data from a total of 44 auscultations relating to tube position and gastrointestinal aspirates for pH were obtained from 32 critically ill adult patients ranging in age from 38,87 years. Results from the auscultatory and pH tests were compared with the location of the tube as determined by radiography. A total of 44 feeding tube applications were investigated using the auscultatory and pH methods and concurrently with X-rays to determine the feeding tube position. Nurses used the auscultatory method to predict tube position, a concurrent researcher aspirated fluid from the feeding tube, and samples were tested for pH within five minutes of radiographs taken to determine tube location. pH was measured with a test strip. Results., Mean pH level in the gastrointestinal aspirates was 4·23 (SD 1·20). Approximately 89% of the pH strip readings from gastrointestinal fluid were between 0,5. A pH of <5 successfully identified 90·4% of the 44 feeding tube cases. Conclusion., The pH method is effective in determining the feeding tube position, but the auscultatory method is not effective in determining the feeding tube position. Relevance to clinical practice., Simple bedside assessment of gastrointestinal aspirate pH is useful for predicting feeding tube position. [source] Post-transfusion white cell count in the sick preterm neonateJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2001IMR Wright Objective: A previous report demonstrated post-transfusion leucocytosis as a potential confounding factor in the diagnosis of sepsis in critically ill adult patients. In We wished to establish if the same phenomenon occurred in the sick preterm neonate and whether this significantly altered the indices considered for potential neonatal infection. Methodology: Transfusion and full blood count data in a level 3 neonatal intensive care unit were prospectively recorded for 3 months. Results: One hundred and fourteen transfusion events were recorded from 37 infants. Median white blood cell count increased 0.9 × 109/L (confidence interval (CI) 0.4,2.4) in the first 8 h following transfusion (P = 0.032). Median neutrophil count increased by 0.4 × 109/L (CI 0.1,1.7) in the same 8 h (P = 0.05). Median neutrophil left shift decreased 1.2% (CI 1.1,5.8%) over the 24 h post-transfusion. No change in band count was observed. Conclusions: A mild post-transfusion white cell increase occurs in sick neonates. Because of the magnitude of effect, it is unlikely that this interesting physiological response would interfere with the diagnosis of sepsis in this population. [source] Progression of Organ Failure in Patients Approaching Brain Stem DeathAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2009F. T. Lytle We performed a retrospective cohort study to document the progression of organ dysfunction in 182 critically ill adult patients who subsequently met criteria for brain stem death (BSD). Patients were admitted to intensive care units (ICUs) of Mayo Medical Center, Rochester, MN, between January 1996 and December 2006. Daily sequential organ failure assessment (SOFA) scores were used to assess the degree of organ dysfunction. Serial SOFA scores were analyzed using analysis of variance (ANOVA). Mean (standard deviation, SD) SOFA score on the first ICU day was 8.9 (3.2). SOFA scores did not significantly change over the course of ICU stay. 67.6% of patients donated one or more organs after BSD was declared. The median time from ICU admission to declaration of BSD was 18.8 h (interquartile range 10.3,45.0), and in those who donated organs, the time from declaration of BSD to organ retrieval was 11.8 h (9.5,17.6). The fact that mean SOFA scores did not change significantly over time, even after BSD occurred, has implications for the timing of retrieval of organs for transplantation. [source] Use of remifentanil as a sedative agent in critically ill adult patients: a meta-analysisANAESTHESIA, Issue 12 2009J. A. Tan Summary This meta-analysis examined the benefits of using remifentanil as a sedative agent in critically ill patients. A total of 11 randomised controlled trials, comparing remifentanil with another opioid or hypnotic agent in 1067 critically ill adult patients, were identified from the Cochrane controlled trials register and EMBASE and MEDLINE databases, and subjected to meta-analysis. Remifentanil was associated with a reduction in the time to tracheal extubation after cessation of sedation (weighted-mean-difference ,2.04 h (95% CI ,0.39 to ,3.69 h); p = 0.02). Remifentanil was, however, not associated with a significant reduction in mortality (relative risk 1.01 (95% CI 0.67,1.52); p = 0.96), duration of mechanical ventilation, length of intensive care unit stay, and risk of agitation (relative risk 1.08 (95% CI 0.64,1.82); p = 0.77) when compared to an alternative sedative or analgesic agent. The current evidence does not support the routine use of remifentanil as a sedative agent in critically ill adult patients. [source] | ||||||||||