Biomedical subjects

Carol Diane Epstein

Publications and source records attributed to Carol Diane Epstein.

3 recordsLinked to original sources

PubMed2006

Weaning readiness and fluid balance in older critically ill surgical patients.

BACKGROUND: Few studies address predictors for successful weaning of older adults from mechanical ventilation. OBJECTIVE: To develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation. METHODS: Forty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed. RESULTS: Compared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (-0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (-0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (P<.001). CONCLUSION: Persistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.

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PubMed2003

Lights! Camera! Action!: video projects in the classroom.

We report on two classroom video projects intended to promote active student involvement in their classroom experience during a year-long medical-surgical nursing course. We implemented two types of projects, Nursing Grand Rounds and FPBTV. The projects are templates that can be applied to any nursing specialty and can be implemented without the use of video technology. During the course of several years, both projects have proven effective in encouraging students to promote pattern recognition of characteristic features of common illnesses, to develop teamwork strategies, and to practice their presentation skills in a safe environment among their peers. The projects appealed to students because they increased retention of information and immersed students in the experience of becoming experts about an illness or a family of medications. These projects have enabled students to become engaged and invested in their own learning in the classroom.

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PubMed2002

Weaning older patients from long-term mechanical ventilation: a pilot study.

BACKGROUND: As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation. OBJECTIVE: To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation. METHODS: After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program. RESULTS: The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower CONCLUSION: Further study of weaning in older adults is warranted.

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