Clinical Pearls

About 30% to 40% of patients who experience acute respiratory distress syndrome (ARDS) in the intensive care unit will die of acute hypoxemic respiratory failure. Although prone positioning improves survival rates in patients with ARDS, the effect on cerebral oxygenation is unclear.Fedun and colleagues assessed the effects of prone positioning on patients admitted with moderate or severe ARDS. They found that during prone positioning, Both the ratio of Pao2 to fraction of inspired oxygen (peripheral oxygenation) and the regional cerebral oxygen saturation, (measured via near-infrared spectroscopy) increased over baseline measurements.Findings support the use of near-infrared spectroscopy as a noninvasive method for measuring brain tissue oxygenation by trained nurses. Although further study with larger samples is warranted, prone positioning was associated with improved cerebral oxygenation.See Article, pp 277–284Titration of vasoactive medications is the responsibility of critical care nurses. The Joint Commission has standards for orders of titration, but nurses’ practice with titration has primarily been autonomous and little research has addressed how nurses make titration decisions.Waterval and colleagues explored nurses’ confidence and decision-making when titrating medications. They found Findings support the use of protocols while also allowing nurse autonomy. The authors recommend clinical decision-making and interprofessional communication skills be integrated into critical care training.See Article, pp e24–e31Accurate blood pressure measurement is essential in the care of critically ill patients. Although many intensive care patients have intra-arterial blood pressure (IABP) monitoring, the associated risks have led to debate about the necessity of IABP monitoring compared with noninvasive blood pressure (NIBP [cuff]) measurement.Becker and colleagues conducted a systematic review and meta-analysis to examine the differences between IABP and NIBP, and the impact of those differences on patient outcomes. They found The authors suggest that clinicians consider the patient’s disease state when determining a method of blood pressure measurement and whether an increased systolic blood pressure measurement will alter the plan of care. Further research exploring the use of ever-changing NIBP technology is needed.See Article, pp e6–e23Family presence has been a standard of acute and critical care since the first American Association of Critical-Care Nurses (AACN) Practice Alert on the topic was published in 2004. Despite backing from many professional organizations and 30 years of research support, family presence is still not standard practice in many settings.Halm and colleagues explain their “Being There” empirical logic model for implementing practice programs for family presence during resuscitation and invasive procedures. They found Although more research is needed on the most effective strategies in team implementation of family presence, the authors recommend that the “Being There” model be used to implement or reinvigorate a family presence program.See Article, pp 302–311