ABSTRACT
Critical care patients are at risk for developing endogenous and exogenous nosocomial infections. Essential components of an infection-control program in the critical care environment are the structural design of the critical care unit and the surveillance, prevention, and control of infection functions. Management strategies include employee infection control and education. Knowledge and education are the most important management tools in the control of infection in the critical care environment.
Subject(s)
Infection Control/organization & administration , Intensive Care Units/organization & administration , Nursing, Supervisory/organization & administration , Humans , Interior Design and Furnishings , Joint Commission on Accreditation of Healthcare Organizations , Outcome and Process Assessment, Health Care , Personnel, Hospital/educationABSTRACT
Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pretreatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. These techniques optimize myocardial preservation while providing adequate cardiac surgery operative times by decreasing the myocardial ischemic period, decreasing cellular metabolic requirements, and preserving energy stores. Awareness of the physiologic consequences of hypothermia in the postoperative cardiac patient improves nursing assessment of the hypothermic patient. Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient.
Subject(s)
Cardiac Surgical Procedures/nursing , Heart Arrest, Induced , Hot Temperature/therapeutic use , Hypothermia, Induced , Postoperative Care , Aged , Body Temperature Regulation , Cardioplegic Solutions , Cardiopulmonary Bypass , Humans , Male , Oxygen ConsumptionABSTRACT
Critical care nurses frequently are involved in obtaining cardiac output measurements and in using these data to assess and to plan therapy. This article reviews the physiologic determinants of cardiac output and the clinical factors that influence these determinants. Principles and techniques of common methods of cardiac output measurement are discussed. A thorough presentation of guidelines for troubleshooting problems with thermodilution cardiac output measurement is provided in a table. Nursing management issues are discussed using relevant nursing research. Future considerations in cardiac output measurement are discussed, and suggestions of an ideal cardiac output system are provided.
Subject(s)
Cardiac Output , Monitoring, Physiologic/methods , Nursing Assessment , Critical Care , Humans , Monitoring, Physiologic/nursing , Nursing ProcessABSTRACT
Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is the treatment goal in patients undergoing coronary artery surgery (CAS). In this study we examined changes in temperature, arterial oxygen saturation (SaO2), cardiac index (CI), oxygen consumption (VO2), and mixed venous oxygen saturation (SvO2) over the initial 4-hour rewarming period in 36 patients having CAS. When patients were admitted to the intensive care unit the mean temperature was 36.27 degrees C, and it increased to 37.50 degrees C; SaO2 was 97.67% at the beginning and end of the 4-hour period; CI was 2.88 L/min/m2 and rose to 3.00 L/min/m2; VO2 was high at 0.320 L/min on admission and remained high at 0.290 L/min at the end of the 4-hour rewarming period; and SvO2 was 70.83% initially and declined to 66.53% in the same period of time. Continuous SvO2 monitoring was valuable in the ongoing assessment and management of the patients in stable, mildly hypothermic condition after CAS during the 4-hour postoperative rewarming period.
Subject(s)
Coronary Artery Bypass/nursing , Critical Care/methods , Oximetry , Postoperative Care/methods , Aged , Body Temperature , Cardiac Output , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Oxygen Consumption , Time FactorsABSTRACT
The purpose of this study was to investigate the effects of position changes on mixed venous oxygen saturation (SvO2) and to describe the mechanisms responsible for SvO2 changes reported to occur with position changes. The study was done from 4 to 8 hours after surgery in 34 patients after coronary artery bypass grafting. Subjects were put through a series of six position changes, including head of bed elevations and right and left lateral decubitus with return to supine between each. Each position was maintained for 30 minutes. SvO2, arterial oxygen saturation (SaO2), and oxygen consumption (VO2) were measured before and after each position change. Overall mean subject data demonstrated a decrease in SvO2 with each of the lateral position changes. The SvO2 did not drop below 60% in these mean data, and this drop returned to baseline by 5 minutes. There were no significant changes in the mean data for VO2 or SaO2. No significant correlation was found in the mean data between SvO2 and VO2 or SvO2 and SaO2 measurements. Trends were demonstrated in five specific cases that suggested a correlation between changes in SvO2 and changes in VO2 and SaO2. In conclusion, this study demonstrated that subjects were able to tolerate position changes with no clinically significant changes in SvO2, SaO2, or VO2.
