Acute lung injury/acute respiratory distress syndrome occurred in more than one third of mechanically ventilated neurosciences critical care unit patients. Loss of the cough or gag reflex is strongly predictive of acute lung injury/acute respiratory distress syndrome, while neurologic diagnosis and Glasgow Coma Scale are not. Lower brainstem dysfunction, a clinical marker of neurologic injury not captured by the Glasgow Coma Scale, is a risk factor for acute lung injury/acute respiratory distress syndrome and could inform decisions regarding airway protection and mechanical ventilation.
Improving management of inpatients with diabetes undergoing vascular surgery requires collaboration among many health care practitioners. This article describes a performance improvement project that implemented two evidence-based algorithmic order sets to guide perioperative glucose management for diabetic patients undergoing vascular procedures and utilized a certified diabetes educator (CDE) to educate health care practitioners. Results showed statistically and clinically significant reductions in infection and differences in mean blood glucose between pre- and postintervention groups, including a direct relationship between glucose control and the level of involvement of a CDE in patient care.
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