Critical Care Newsline — February 5, 2009

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

Feb. 5, 2009

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1. EVIDENCE Precedex as Effective as Midzolam to Sedate Mechanically Ventilated Patients
2. EVIDENCE Atypical Antipsychotic Drugs Carry High Risk of Sudden Cardiac Death
3. EVIDENCE Field Triage Updates: Right Treatment, Right Place, Right Time
4. NEWS TRENDS Paper and Pencil Certification Exams Application Deadline Extended to Feb. 16
5. CALL FOR APPLICATIONS Venous Thromboembolism Grants
6. RESOURCE Spanish Language Guide to Safe, Effective Use of Coumadin
7. CALL FOR ABSTRACTS Live Educational Sessions for NTI 2010 in Washington, D.C.
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Precedex as Effective as Midzolam to Sedate Mechanically Ventilated Patients
Precedex (dexmedetomidine hydrochloride) provides comparable effectiveness to commonly used midazolam for greater-than-24-hour sedation of mechanically ventilated ICU patients, according to a recent study. The study’s authors also found patients sedated with Precedex were removed from mechanical ventilation almost two days earlier, and the prevalence of delirium in Precedex-treated patients was 22.6 percent less than in patients treated with midazolam. Precedex-treated patients were more likely to develop bradycardia, or slow heartbeat, but less likely to have tachycardia (fast heartbeat) or hypertension that required treatment. Providing sedation for patient safety and comfort is an integral component of bedside care for nearly every patient in the ICU, and practice guidelines for sedation in the ICU have identified the need for well-designed randomized trials comparing the effectiveness of different sedative agents for important clinical outcomes. "This multicenter study is one of the largest to compare two different sedatives for use in the ICU in a randomized and blinded design," reported the authors "There are more than 5 million patients treated annually in the ICU. In 2003, there were nearly 300,000 prolonged mechanical ventilation discharges in the United States at an annual aggregated hospital cost of more than $16 billion. At a cost of more than $1,500 per patient-day, mechanical ventilation represents a significant contribution to overall expenses in the intensive care setting and drives a disproportionate share of resource utilization.”

For more information on this topic, check out AACN Protocols for Practice: Care of the Mechanically Ventilated Patient, 2nd Ed., available for purchase through AACN’s Online Bookstore.

2. EVIDENCE Atypical Antipsychotic Drugs Carry High Risk of Sudden Cardiac Death
Patients treated with atypical antipsychotics such as risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa) and clozapine (Clozaril) risk sudden cardiac death just like those taking typical antipsychotics; and those taking either type of antipsychotic faced significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to a new study. Atypical antipsychotics are commonly used to treat schizophrenia and bipolar disorders. They are also prescribed off-label for symptoms such as agitation, anxiety, psychotic episodes and obsessive behaviors. Although atypical antipsychotics are less likely to cause tremors and other serious movement disorders than typical antipsychotics such as haloperidol (Haldol) and thioridazine (Mellaril), the study’s authors concluded “atypical antipsychotics are not a safer alternative to typical antipsychotics in preventing death from sudden cardiac causes.”

3. EVIDENCE Field Triage Updates: Right Treatment, Right Place, Right Time
Newly revised field triage guidelines published by the Centers for Disease Control and the National Expert Panel on Field Triage standardize decision-making at the scene of an injury and offer guidance on new technologies such as vehicle crash notification systems, which alert emergency services when a crash occurs and automatically summons assistance. “Quality and timely care at an injury scene by EMS providers are integral to determining the severity of injury, initiating medical management, and identifying the most appropriate facility to which the patient should be transported,” noted an author of the report, adding, “it can help improve the chances of survival for severely injured patients.”

4. NEWS TRENDS Paper and Pencil Certification Exams Application Deadline Extended to Feb. 16
Is 2009 the year for you to enhance your skills and knowledge with a new credential? Here’s the perfect opportunity: Paper and pencil exams for the CCRN, PCCN, CCNS, ACNPC, CMC, CSC, and CNML will be given at the spring Trends conference in Philadelphia on March 27, 2009. The deadline to submit Trends exam applications to AACN has been extended to Feb. 16, 2009.

5. CALL FOR APPLICATIONS Venous Thromboembolism Grants
Applications are being accepted for The American College of Chest Physicians and The CHEST Foundation Grants in Venous Thromboembolism (VTE). ACCP members who propose an interventional project that includes evidence-based, replicable programs and tools to address the current gaps in VTE prophylaxis and management are eligible. Applications must be postmarked on or before Feb. 20, 2009.

6. RESOURCE Spanish Language Guide to Safe, Effective Use of Coumadin
The AHRQ has published a new pamphlet, “Su Guía Para el Tratamiento con Coumadin/warfarina” (Your Guide to Coumadin/Warfarin Therapy), to educate Spanish-speaking patients who take this blood thinner.
The easy-to-read brochure educates patients about the blood thinner and its potentially dangerous side effects, explains how to communicate effectively with healthcare providers and provides tips for lifestyle modifications. Click here or e-mail ahrqpubs@ahrq.hhs.gov to receive a copy.

7. CALL FOR ABSTRACTS Live Educational Sessions for NTI 2010 in Washington, D.C.
AACN is accepting abstracts for live educational sessions to be presented at NTI 2010. Abstracts selected for presentation must reflect AACN’s mission, vision and values; support AACN’s major areas of interest; link research and practice; present cutting edge information and contain precise, comprehensive content. The deadline is June 1, 2009.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Intracranial Pressure Monitoring During Percutaneous Tracheostomy "Percutwist" in Critically Ill Neurosurgery Patients

Management of Traumatic Brain Injury: Nursing Practice Guidelines for Cerebral Perfusion and Brain Tissue Oxygenation (PbtO2) Systems

Pediatric Antifungal Utilization: New Drugs, New Trends

Continuous Renal Replacement Therapy Amino Acid, Trace Metal and Folate Clearance in Critically Ill Children

GUIDELINES
Adult Weight Management Evidence-based Nutrition Practice

Critical Illness Evidence-based Nutrition Practice

Pediatric Weight Management Evidence-based Nutrition Practice

PATIENT SAFETY ISSUES
Ethex Corp. Recalls Prescription Prenatal Vitamin and Iron Supplement Products

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