Acute pulmonary disease accounts for a significant proportion of patients admitted to the intensive care unit and ultimately increases the risk of death. Moreover, if patients survive an acute stage of pulmonary disease, they may be left with chronic respiratory problems that severely alter their quality of life and pose unmanageable economic burdens on individuals, families, and society in general. New therapies and techniques in the monitoring and management of acute pulmonary disease states emerge steadily as research findings are disseminated. However, it is challenging for acute care nurses to stay abreast of the latest options and to be knowledgeable regarding evidence-based practice guidelines to facilitate optimal outcomes for these patients.
This issue of Critical Care Nursing Quarterly is the first of 2 issues to address specific pulmonary disease states from the perspective of advanced practice nursing management in collaboration with medical practice. Each disease will be reviewed and current management guidelines will be discussed. The role of the nurse will be highlighted and emerging therapies will be discussed. This issue will focus on acute asthma, nosocomial pneumonia, community-acquired pneumonia, and mechanical ventilation. The next issue will address respiratory failure, pulmonary embolism, acute respiratory distress syndrome, and acute exacerbations of chronic obstructive pulmonary disease.
Asthma rates have increased worldwide and are predicted to continue increasing in future years. Although asthma attacks often result from an inadequate outpatient program, adequate knowledge regarding management of acute exacerbations of asthma is imperative for practitioners in the acute and critical care settings. Corbridge and Corbridge review the current thoughts on pathophysiology, presentation, diagnosis, and management (including mechanical ventilation) of acute exacerbations of asthma.
Knowledge of the clinical presentation and management of community-acquired pneumonia (CAP) is important for critical care practitioners as up to 20% of patients require hospitalization and inpatient management. Kleinpell and Elpern provide a review of the risk factors for CAP and discuss evidence-based recommendations for diagnosis and management.
Nosocomial pneumonia, the second most frequent hospital infection, has been identified for over a century. Both nosocomial and, more specifically, ventilator-acquired pneumonia continue to claim lives and account for both rising healthcare costs and increased rates of antibiotic-resistant strains of bacteria. While nosocomial pneumonia is a common infection in the intensive care unit, it is theoretically largely preventable. Myrianthefs, Kalafati, Samara, and Baltopoulos examine the epidemiology and pathophysiology of nosocomial pneumonia and discuss current guidelines for choices and management of antibiotic therapy.
Mechanical ventilation has advanced in both technology and application over the past several decades. Medical residents and intensive care nurses are responsible for minute-to-minute and hour- to-hour management of patients on ventilators. However, both physicians and nurses report that they are not adequately educated and are ill prepared by formal education to assess waveforms and incorporate this data into daily management of patients.
Fenstermacher and Hong's review of mechanical ventilation is meant to serve as an in-depth reference for practitioners at the bedside. They discuss newer modes of mechanical ventilation with regard to the pathophysiologic state of patients with specific disease states. Relevant current research is discussed, which includes lung protective strategies as an important consideration in ventilatory management of patients. This comprehensive article includes the history of ventilators and describes not only modes and settings, but also details the parameters to evaluate during ventilatory management, with a discussion of pros and cons regarding specific management techniques. Complications of ventilatory therapy and weaning methods are included with the presentation of current indices and criteria utilized to assess readiness to wean.
As this issue is disseminated, our hope is that readers will come away with the most current knowledge regarding the acute respiratory topics covered. Specifically, the role of the nurse in acute care settings should clearly be prominent and may serve to guide and confirm current practice in the acute phases of treatment for asthma, CAP, nosocomial pneumonia, and for those patients being managed on mechanical ventilators.