This issue of the journal is a compilation of manuscripts worthy of publication but ones that did not fit squarely into our topical format observed by Critical Care Nursing Quarterly. However, the manuscripts that have been selected are certain to stimulate discussion about ongoing clinical decisions and evolving practices encountered in today's intensive care unit (ICU).

Zhang and Melander consider a novel procedure for a select group of patients with aortic stenosis who are at risk for typical surgical intervention. In their article, "Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis," they review the procedure and its potential complications and outline essential nursing care to ensure optimum outcomes.

Acute heart failure accounts for more than 1 million hospitalizations each year in the United States. Paul and Hice's article, "Role of the Acute Care Nurse in Managing Patients With Heart Failure Using Evidence-Based Care," emphasizes elements of care during acute decompensation and outlines strategies required to ensure successful rehabilitation and prevent recurrence of decompensation.

Dixon and Keasling present a report of one hospital's quality improvement initiative related to using therapeutic hypothermia to reduce neurologic injury and mortality among patients who had experienced cardiac arrest in association with an acute ST-segment elevated myocardial infarction (STEMI). In the article, "Development of a Therapeutic Hypothermia Protocol: Implementation for Postcardiac Arrest STEMI Patients," they describe their hospital's multidisciplinary team protocol for therapeutic hypothermia and explain its impact on postarrest survival and morbidity.

"Preventing Ventilator-Associated Events: Complying With Evidence-Based Practice" by Munaco and colleagues compels us to reexamine our clinical approaches and oversight of patients dependent upon mechanical ventilatory support. These authors emphasize that the effectiveness of care bundles is often curtailed by limitations within the electronic medical record systems. Initiatives to improve bundle compliance should include new documentation methods and strategies to permit straightforward data collection.

Nolen and Warren tackle an age-old and ongoing issue in their article "Meeting the Needs of Family Members of ICU Patients." One area of concern is the provision of more comfortable and relaxing waiting areas where visitors can cope with the emotional burdens and physical exhaustion that often accompany a health care crisis. Health care personnel must be vigilant in ensuring that visitors are accommodated and supported since they are an integral factor in the patient's healing and recovery.

Finally, Davidson and her coauthors present a thought-provoking article "Using Evidence to Overcome Obstacles to Family Presence." They discuss the myths and realities surrounding common beliefs that non-health care personnel at the at the bedside may contribute to infections, have adverse effects on the physiological status of patients, interfere with bedside teaching, and serve as a deterrent to open communication during exchange reports and clinical rounds. A case study serves as a basis for strategies to overcome obstacles to family presence in the hospital.

This issue of Critical Care Nursing Quarterly should spark discussions and new thinking among ICU nurses. It is hoped that the information and advancements that authors share in their work will ignite passions for changing practices and streamlining clinical decision making.

-Constance A. Hoyt, MSN, RN, FAAFS

Issue Editor