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Tom Ahrens

Publications and source records attributed to Tom Ahrens.

9 recordsLinked to original sources
PubMed2004

Monitoring carbon dioxide in critical care: the newest vital sign?

Carbon dioxide (CO(2)) monitoring can yield substantial information about cardiac and pulmonary function. Because capnography is not complicated, it is relatively easy to apply in a wide variety of clinical settings. A new area of CO(2) measurement is sublingual CO(2). Although outcomes data are as yet unavailable for this technology, its ease of use makes it an attractive monitoring tool to assess severity of illness and predict patients' responses to therapy. This article describes the pathophysiology and clinical applications of the technologies and describes why they may well be "the newest vital signs."

Adult↗
PubMed2003

Capnography application in acute and critical care.

The use of capnography has expanded over recent years. Currently, capnography is used in a variety of acute care settings. This article describes what capnography is and how it is used. The normal and abnormal capnogram or waveforms are described to assist in identifying various clinical situations. The multiplicity of clinical indications include detection of pulmonary embolism as well as malpositioned endotracheal/tracheal, gastric, and small bowel tubes. Capnography also provides clinicians with information regarding expiratory breathing patterns and assists in perfusion assessments such as those for cardiopulmonary resuscitation. Finally, case studies are provided to help the reader apply the concepts of capnography to a variety of acute care settings.

Acute Disease↗
PubMed2003

Improving family communications at the end of life: implications for length of stay in the intensive care unit and resource use.

BACKGROUND: Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization. OBJECTIVES: To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit. METHODS: During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician. RESULTS: Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15,559 vs $24,080) and variable ($5087 vs $8035) costs. CONCLUSIONS: Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.

Aged↗
PubMed2003

Severe sepsis management are we doing enough?

For the first time in medical history, a drug has been shown to reduce the mortality associated with sepsis, the leading cause of death in many ICUs. Optimal use by appropriate selection of patients and early recognition of sepsis could save thousands of lives. Nurses play a major role in recognizing severe sepsis. By using the concepts introduced here, nurses can play a direct role in saving the lives of patients with sepsis.

Adult↗
PubMedDate not supplied

Evidenced-based practice: priorities and implementation strategies.

Evidenced-based practice (EBP) should be a driving force behind establishing optimal clinical practices. Recently, clinicians and hospitals have started efforts to introduce key EBP. These efforts hold the potential to improve patient outcomes and reduce costs. However, many practices need updating with EBP. Which ones should be chosen? While practices often vary in terms of importance for each hospital, some changes in practice are likely to have a better return on the investment (ROI). Two key areas affecting most hospitals are practices associated with high costs and increased mortality. In critical care areas, these two key areas often involve addressing outlier management and severe sepsis. In addition, the recognition of the need for the change is only one step in ensuring EBP. To ensure EBP is implemented, clinical leaders who will ensure that the new practice standards are being utilized are necessary. Fortunately, many hospitals have strong leaders. The advanced practice nurse (APN) is one such leader. The APN is often in a unique position to help recognize, prioritize, and implement EBP into the hospitals culture. This article illustrates steps in making EBP a reality by highlighting the management of outliers and severe sepsis and the implementation strategies for these conditions.

Bias↗
PubMedDate not supplied

Hemodynamics in sepsis.

Hemodynamics in sepsis change as sepsis develops. Initial hemodynamics of sepsis often are much different from later stages of sepsis, shifting from low cardiac output states to high cardiac output states. Tissue oxygenation also changes with initial mixed venous oxyhemoglobin (Svo2) or central venous oxyhemoglobin (Scvo2) levels below normal, with later stages reflecting high values. These changes occur as sepsis progresses, producing a marked disturbance in capillary flow and tissue oxygenation. Treatments for these changes in sepsis are different, making the identification of the hemodynamic state essential to optimally treat the patient. Fortunately, hemodynamic monitoring techniques are markedly improved from older techniques such as the pulmonary artery catheter. With noninvasive techniques such as esophageal and external Doppler for measuring hemodynamics, clinicians beyond the intensive care unit can make hemodynamic assessments that were not possible until just recently. This improved assessment should make it much easier to properly identify sepsis and initiate appropriate treatments in a timely manner.

Blood Flow Velocity↗