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This updated edition includes new interviews from acute care, critical care, perioperative nurses, and more. Attention is paid to current IOM and nursing guidelines for systems approaches to patient safety, with education and leadership implications described throughout. It is an essential resource for undergraduate and graduate nursing educators, students, administrators, and managers seeking to improve systems of care and leadership in clinical practice.

Advanced Practice in Critical Care provides experienced critical care nurses with a clear and distinct evidence base for contemporary critical care practice. Central to the book is the application of research and evidence to practice and therefore, case studies and key critical care clinical situations are used throughout to guide the reader through the patient care trajectory. Each chapter introduces an initial patient scenario and as the chapter progresses, the patient scenario develops with the theoretical perspectives and application. In this way, it is evident how multi-organ dysfunction develops, impacting upon and influencing other body systems, demonstrating the multi-organ impact that is often experienced by the critically ill patient. In this way, consequences of critical illness such as acute renal failure, haemostatic failure and liver dysfunction are explored. Throughout the text, key research findings and critical care treatment strategies are referred to, applied and evaluated in the context of the given patient case study. Advanced assessment techniques are explained and the underlying pathophysiology is discussed in depth. Advanced Practice in Critical Care is an essential resource for experienced practitioners within critical care whom primarily care for patients requiring high dependency or intensive care.

Background Enteral nutrition (EN) is recommended as the preferred route for early nutrition therapy in critically ill adults over parenteral nutrition (PN). A recent large randomized controlled trial (RCT) showed no outcome differences between the two routes. The objective of this systematic review was to evaluate the effect of the route of nutrition (EN versus PN) on clinical outcomes of critically ill patients. Methods An electronic search from 1980 to 2016 was performed identifying relevant RCTs. Individual trial data were abstracted and methodological quality of included trials scored independently by two reviewers. The primary outcome was overall mortality and secondary outcomes included infectious complications, length of stay (LOS) and mechanical ventilation. Subgroup analyses were performed to examine the treatment effect by dissimilar caloric intakes, year of publication and trial methodology. We performed a test of asymmetry to assess for the presence of publication bias. Results A total of 18 RCTs studying 3347 patients met inclusion criteria. Median methodological score was 7 (range, 2–12). No effect on overall mortality was found (1.04, 95 % CI 0.82, 1.33, P  = 0.75, heterogeneity I 2  = 11 %). EN compared to PN was associated with a significant reduction in infectious complications (RR 0.64, 95 % CI 0.48, 0.87, P  = 0.004, I 2  = 47 %). This was more pronounced in the subgroup of RCTs where the PN group received significantly more calories (RR 0.55, 95 % CI 0.37, 0.82, P  = 0.003, I 2  = 0 %), while no effect was seen in trials where EN and PN groups had a similar caloric intake (RR 0.94, 95 % CI 0.80, 1.10, P  = 0.44, I 2  = 0 %; test for subgroup differences, P  = 0.003). Year of publication and methodological quality did not influence these findings; however, a publication bias may be present as the test of asymmetry was significant ( P  = 0.003). EN was associated with significant reduction in ICU LOS (weighted mean difference [WMD] -0.80, 95 % CI −1.23, −0.37, P  = 0.0003, I 2  = 0 %) while no significant differences in hospital LOS and mechanical ventilation were observed. Conclusions In critically ill patients, the use of EN as compared to PN has no effect on overall mortality but decreases infectious complications and ICU LOS. This may be explained by the benefit of reduced macronutrient intake rather than the enteral route itself.

Investigators evaluated the caregivers of patients who had received mechanical ventilation for at least 7 days in an ICU. Although there was a large burden of depressive symptoms soon after discharge, the burden diminished in magnitude, in most caregivers, during the subsequent year. Unpaid caregivers (typically family or close friends) are essential to the sustainability of North American health care systems, because their unpaid labor annually accounts for $27 billion in Canada and $642 billion in the United States. 1 , 2 More than half the patients who have received prolonged mechanical ventilation during a stay in the intensive care unit (ICU) and have survived to discharge continue to require assistance from a caregiver 1 year after ICU discharge. 3 Although caregiver assistance can be beneficial for patients, such care may have negative consequences for caregivers, including poor health-related quality of life, 4 emotional distress, 4 – 8 a . . .

Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear. In patients with ABI, sedation has ‘general’ indications (control of anxiety, pain, discomfort, agitation, facilitation of mechanical ventilation) and ‘neuro-specific’ indications (reduction of cerebral metabolic demand, improved brain tolerance to ischaemia). Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control. Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics. Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g. intracranial pressure elevation) and the potential benefits of enhanced neurological function and reduced complications. In this review, we provide a concise summary of cerebral physiologic effects of sedatives and analgesics, the advantages/disadvantages of each agent, the comparative effects of standard sedatives (propofol and midazolam) and the emerging role of alternative drugs (ketamine). We suggest a pragmatic approach for the use of sedation-analgesia in the NICU, focusing on some practical aspects, including optimal titration and management of sedation withdrawal according to ABI severity.

\"[This book] offers easy-to-use, quick tips that will benefit a great number of nurses.Critical care nurses often need help with ventilator modes and types of usage and this book is a great resource.\" Score: 96, 4 Stars.--Doody's Medical Reviews The only book written about mechanical ventilation by nurses for nurses, this text fills a void in.

Because ER nurses need to think fast and act fast...Fast Facts for the ER Nurse is the only orientation guide and reference designed specifically for new ER nurses and the preceptors responsible for their orientation.

Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes.

Background The optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of “early” versus “late” RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic. Methods A literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to “early” versus “late”/“standard” criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS). Results Thirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with “early” RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384–1.153, p  = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of “early” (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies. Conclusions Our conclusion based on this evidence synthesis is that “early” initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS.

What is already known•Ocular surface disorders affect 13.2–59.4% of ICU patients and may cause severe vision loss if untreated.•Risk factors include lagophthalmos, sedation-induced blink reduction, and systemic inflammation lowering tear production.•ICU nurses often lack standardized ocular care protocols and sufficient training, causing inconsistent practices.•Educational programs in critical care improve nursing practices and patient outcomes, suggesting potential in ocular care. What this paper adds:•A structured educational intervention enhanced ICU nurses' knowledge, assessments, and adherence to ocular care guidelines.•The intervention significantly reduced the incidence of ocular surface disorders among ICU patients.•Results emphasize integrating standardized ocular care and ongoing nurse education into ICU protocols. Ocular surface disorders (OSDs) are common in intensive care unit (ICU) patients, with incidence rates ranging from 13.2% to 59.4%. Risk factors include impaired eyelid closure, reduced blink reflexes, and systemic inflammation, exacerbated by sedation and mechanical ventilation. Despite these risks, ICU nurses often lack standardized ocular care training, leading to inconsistent practices and suboptimal patient outcomes. To evaluate the impact of a structured educational intervention on ICU nurses’ regarding ocular care in critically ill patients. A non-randomized clinical trial was conducted in a tertiary hospital in Spain, including 161 ICU patients (80 pre-intervention; 81 post-intervention) requiring ≥ 48-hour mechanical ventilation and sedation. The study involved a pre-intervention observational phase followed by a structured educational program for ICU nurses on evidence-based ocular care consisting of a one-hour in-person session combining theoretical content, bedside demonstration, and distribution of supporting visual materials. Clinical outcomes and adherence to care protocols were analysed using chi-square tests, t-tests, and logistic regression. The incidence of OSDs decreased from 76.3 % pre-intervention to 38.3 % post-intervention (p < 0.001). Significant reductions were observed in dry eye (40 % to 9.9 %), lagophthalmos (43.8 % to 19.8 %), red eye (38.8 % to 12.3 %), and ocular oedema (48.8 % to 29.6 %). Early ocular care implementation increased from 33.8 % to 71.6 % (p < 0.001), and adherence to evidence-based care protocols improved from 80 % to 93.8 % (p < 0.01). Post-intervention care was strongly associated with a lower OSD risk (adjusted OR: 0.21; 95 % CI: 0.11–0.43; p < 0.001). A structured educational intervention significantly reduced the incidence of OSDs and improved adherence to evidence-based ocular care practices in ICU settings. Integrating evidence-based ocular care protocols into ICU routines reduces OSD incidence and enhances patient outcomes. Nurses training and institutional support are essential for sustaining adherence, improving patient safety, and minimizing preventable ocular complications in critically ill patients.