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Biomedical subjects

J M Clochesy

Publications and source records attributed to J M Clochesy.

At least 19 recordsLinked to original sources
PubMed1995

Weaning chronically critically ill adults from mechanical ventilatory support: a descriptive study.

BACKGROUND: Ventilator-dependent patients average 11,419 daily in US acute care hospitals. OBJECTIVE: To describe the process of ventilatory weaning among chronically critically ill adults. METHODS A retrospective survey was used to study ventilator-dependent adults enrolled in a larger randomized study. Patients records were used to obtain duration of mechanical ventilatory support, success of weaning, serum albumin level, left ventricular function, number of drugs used to treat heart failure, and 24-hour fluid balance. Data were collected on admission to the intensive care unit; 24 hours after initiation of mechanical ventilation; and 7 days before, and on the day of, weaning status determination. RESULTS: Of 174 subjects, 120 were weaned from mechanical ventilation. There were no differences in maximum inspiratory pressure, minute ventilation, or ventilatory capacity between successful and unsuccessful candidates. There were differences in serum albumin level, rapid shallow breathing index, fraction of inspired oxygen, and 24-hour fluid balance. Among subjects who were weaned, the duration of mechanical ventilation was significantly longer in those with left ventricular dysfunction (n = 53; 29.1 +/- 25.2 days) than in those with normal left ventricular function (n = 67; 21.1 +/- 18.1 days). Subjects who were weaned received a greater number of drugs to treat heart failure (1.46 +/- 1.24) than did those who were not (0.77 +/- 1.04). CONCLUSIONS Many weaning parameters do not differentiate patients able to be weaned from those who are unable. The presence of left ventricular dysfunction, number of drugs used to treat heart failure, serum albumin level, and 24-hour fluid balance were associated with weaning success and/or duration of mechanical ventilation in adults requiring prolonged mechanical ventilation.

Adolescent↗
PubMed1995

Acute care nurse practitioner curriculum: content and development process.

Curriculum development for preparation of acute care nurse practitioners requires a comprehensive process. To develop a program for their preparation at a large university, the faculty examined needs of the target patient population and care delivery system; scope of acute care nurse practitioner practice; current guidelines for the education of primary care nurse practitioners; evolving guidelines for the didactic and clinical education of acute care nurse practitioners; educational requirements of governing or licensing and certifying bodies; and placement of this new role within the existing healthcare team structure. A curriculum was then developed using a collaborative, multidisciplinary approach.

Acute Disease↗
PubMed1995

Weaning from long-term mechanical ventilation.

Although many investigators have attempted to identify weaning predictors and weaning modes for use in long-term mechanically ventilated patients, none has emerged as superior. Furthermore, few investigators have viewed the process of weaning as a dynamic continuum; thus, guidelines for care of these patients have yet to be developed. Facilitative methods and therapies to enhance weaning potential, although attractive, have little scientific basis for application. Care delivery systems, which focus on systematic, comprehensive and coordinated care, are promising because outcomes demonstrate that they are economical, safe, and effective. This article reviews the research on weaning adult, long-term mechanically ventilated patients, suggests future research directions, and highlights the scientific basis for practice guidelines.

Adult↗
PubMed1994

Caring for patients with acute intermittent porphyria.

The porphyrias are a group of metabolic disorders of heme biosynthesis genetically determined defects. Acute intermittent porphyria is the most common form of porphyria found in the United States. It is caused by a genetic defect in chromosome 11, where one of two genes for porphobilinogen deaminase is defective. Acute intermittent porphyria is characterized by intermittent, acute, occasionally fatal attacks of abdominal, neurologic, psychiatric, and renal symptoms. Attacks are often confused with acute abdomen or bowel obstruction. A variety of drug, hormonal, nutritional, and infectious factors can precipitate clinical symptoms. Managing patients with acute intermittent porphyria involves removing the precipitating factors, increasing carbohydrate intake, controlling pain, and administering medications. A case study is provided.

Adult↗
PubMed1994

Terminal weaning from mechanical ventilation: a review.

Terminal weaning is a clinical intervention for withdrawing mechanical ventilatory support when such support is an unacceptable outcome for a patient. Withdrawal of life support must be done in a humane manner for the patient, the family, and the patient's care providers. Research-based directions for clinical practice are limited because of the paucity of research in this area. Recommendations for future study are related to methods, facilitative therapy, patient, family, and caregiver responses, and care delivery models.

Family↗
PubMed1994

Weaning from mechanical ventilation: concept development.

This article, the first in a series, is written to clarify the process of weaning from mechanical ventilation and to promote the development of a common language for understanding the complex weaning process. The Third National Study Group on Weaning From Mechanical Ventilation proposes a conceptual model and definitions that will provide a framework for future research on this important topic. This conceptual framework describes the preweaning phase, the weaning process, and the outcome phase of mechanical ventilation. Potential outcomes are completion of weaning, lack of completion, and terminal weaning. The weaning decision continuum incorporates: (1) when and how to begin the weaning process, (2) how to select therapies to assist with difficult weaning and chart progress during weaning, and (3) when to stop weaning if progress is no longer being made. An inherent assumption of this model is that each patient will display unique responses to the weaning process. The proposed conceptual framework and definitions provide a foundation for developing clinical practice guidelines and for guiding future ventilator weaning research.

Decision Making↗
PubMed1994

Weaning from short-term mechanical ventilation: a review.

The purposes of this article are to: identify gaps in the research literature on weaning adult patients from short-term mechanical ventilation, highlight the scientific base for practice guidelines, and suggest future research directions. Data bases from 1989 through June 1993 were reviewed, and relevant research articles were extracted, analyzed, and synthesized within the AACN Third National Study Group framework. Seminal work and other supportive literature also were used in this review. Despite considerable research on predictors and patient responses to weaning from short-term mechanical ventilation, few of the findings can be applied to clinical practice at this time. Less research is available on weaning modes and therapies that facilitate weaning from short-term mechanical ventilation; fruitful research in these areas depends in part on a better understanding of patient responses and accurate weaning predictors.

Dyspnea↗
PubMed1994

Preparing advanced practice nurses for acute care.

BACKGROUND: As a result of changes occurring in healthcare, providers have become increasingly specialized, resulting in fragmented care of patients and their families. With these changes, the need has developed for professionals who possess both advanced clinical decision-making ability and expanded psychomotor skills to serve as case managers in collaboration with physicians. As a result, evolving and innovative roles for advanced practice nurses have developed in American hospitals. The development of such roles, within the acute care hospital environment, has led directly to the creation of graduate programs to prepare acute care nurse practitioners. OBJECTIVE: This article describes the efforts to develop a specific graduate program to prepare nurses as acute care nurse practitioners. These efforts include the needs assessment, curriculum and role development, implementation, and evaluation of the program. RESULTS: Phase 1 evaluation showed significant support for acute care nurse practitioners. External support for the training and use of nurse practitioners in acute care was evidenced by significant financial support for this program provided by an acute care hospital and a private foundation. The first graduates are now practicing as acute care nurse practitioners; Phase 2 evaluation of patient outcomes is under way. CONCLUSION: The emergence of acute care nurse practitioners has been stimulated by changes in American healthcare. Support for the use of acute care nurse practitioners is significant, but barriers to implementing the role and patient and fiscal outcomes must be studied.

Acute Disease↗
PubMed1994

Latex hypersensitivity: an iatrogenic and occupational risk.

BACKGROUND Immediate hypersensitivity reactions to natural rubber and latex products were first reported in 1979 by Nutter, who identified contact urticaria to latex gloves. Since that time, numerous cases of immediate and delayed reactions to latex have been reported. Because latex products are ubiquitous, especially in the critical care environment, there is increasing risk of hypersensitivity among patients and healthcare workers. METHOD Literature review. OBJECTIVES To review the types of allergic reaction to latex and to inform healthcare providers of the risks to patients and themselves of acquiring latex hypersensitivity. CONCLUSION Immediate hypersensitivity reactions to natural rubber and latex products pose a significant threat to patients, healthcare workers, and the general population. Medical history alone is inadequate to identify all persons at risk. Numerous proteins doubtless exist in latex that may be the link to allergenicity. Further research is needed to address demographic, behavioral, environmental, and biogenetic factors including gender differences, ethnicity and race.

Gloves, Surgical↗
PubMed1993

Comparison of the effect of insulated and noninsulated head covers on heat loss during abdominal surgery.

Hypothermia is experienced by all patients undergoing major surgical procedures. Hypothermia can lead to postoperative complications affecting oxygenation with neurologic, immunologic, and metabolic consequences. Current methods of heat conservation used in the operating room include blanket warmers, fluid warmers, and anesthesia circuit warmers. These methods are often inadequate at maintaining a patient's body temperature. The current study used a post-test-only control group design. Subjects in the treatment group had an insulated head cover applied within 1 minute of arrival in the operating room, while those in the control group did not. All subjects had routine heat conservation measures (blanket warmers, fluid warmers, and anesthesia circuit humidifiers). Following induction of anesthesia, subjects' temperatures were measured using an esophageal stethoscope with thermistor probe at 10 and 70 minutes. Results showed no significant differences between groups at either time point.

Adult↗
PubMed1992

Evaluation of a system for intragastric pH monitoring of intensive care unit patients: preliminary report.

BACKGROUND: A new pH probe-tipped nasogastric sump tube is available to monitor gastric pH conveniently. This study assesses its ability to measure gastric acidity accurately. METHODS: The accuracy of the combined pH probe nasogastric tube (GrapHprobe ST) was determined by comparing it with standard buffer solutions (pH 1.0, 2.0, 4.0 and 7.0) traceable to the National Institute of Standards and Technology. Gastric pH values obtained were compared with values obtained using indicator paper and a calibrated glass electrode on gastric aspirate. RESULTS: Although statistically significant differences were found in vitro between the pH of three of the buffer solutions and the pH values obtained by the nasogastric sump tube, the results were within 0.5 pH unit. When rounded to the nearest pH unit, all values were the same as the buffer solutions. No significant difference was found in the pH values obtained during in vivo testing. CONCLUSIONS: The GrapHprobe ST measured gastric pH within reasonable accuracy in this small series.

Buffers↗
PubMed1991

Effect of transport time and FiO2 on SpO2 during transport from the OR to the PACU.

Early postoperative hypoxemia may be due to a reduced functional residual capacity, hypoventilation, and ventilation-perfusion mismatch. These factors reduce the partial pressure of the arterial oxygen which ultimately reduces the oxygen transported to the tissues by decreasing the hemoglobin saturation. This may lead to cellular ischemia and death. Oxygen saturation may decrease during transport from the operating room to the postanesthesia care unit. The length of transport time in large operating suites may exceed 5 minutes, which may lead to inadequate oxygenation. This research used a pretest-posttest control group design on a convenience sample. Subjects were randomized into either the treatment or control group. At emergence, the SpO2 measured and the stopwatch started. The treatment group received 40% oxygen via a venturi mask during transport while the control group breathed room air. After a routine transport to the postanesthesia care unit, the SpO2 was again measured and the transport time was recorded. Oxygen saturation was found to be significantly greater in the group breathing supplemental O2 during transport.

Adult↗
PubMed1991

Electrode site preparation techniques: a follow-up study.

A posttest-only control group design was used to study the effect of electrode site preparation techniques on reducing electrical potential across a pair of disposable skin electrodes. One hundred twenty healthy volunteers were randomly assigned into one control and three treatment groups of 30 subjects each. The three treatments were One Step Skin Prep used once, ECG Prep Pad used five times, and ECG Prep Pad used once. To control for handedness, the skin preparation site was randomly assigned to either the left or right forearm. One-tailed paired t-test analyses were used to compare differences between treatment arms and control arms within each group (p less than 0.05). Skin preparation done by using One Step Skin Prep or the ECG Prep Pads used once significantly decreased skin potentials by 2.3 mV and 3.3 mV respectively. There was no significant difference in the control group and the group in which ECG Prep Pads were used five times. These findings extend the knowledge of techniques available to reduce the amount of noise (electrical potential) in physiologic measurement using skin electrodes.

Adult↗
PubMed1989

Comparison of electrode site preparation techniques.

A posttest-only control group design was used to study the effects of two electrode site preparation techniques on reducing electrical potential across a pair of disposable skin electrodes. Sixty health volunteers were randomly divided into one control and two treatment groups of 20 subjects each. Within each group, the treatment was further assigned randomly to either the right or left forearm. Analysis of variance and paired t test analyses were used to compare group differences. Skin preparation by using One Step Skin Prep significantly decreased skin potentials (-1.90 mV) whereas the group in which ECG Prep Pads were used and the control group had no significant change.

Electric Conductivity↗