What is the best treatment for hypertensive disorders of pregnancy?

Posted on July 15, 2021 by Sharon

“All oral anti-hypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs—methyldopa, nifedipine, and labetalol—are viable initial options for treating severe hypertension in low-resource settings.”¹

“Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available.”²

(1) Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, von Dadelszen P, Shochet T, Winikoff B. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet. 2019 Sep 21;394(10203):1011-1021. doi: 10.1016/S0140-6736(19)31282-6. Epub 2019 Aug 1. PMID: 31378394; PMCID: PMC6857437.
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(2) Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020 Nov 1;6(6):384-393. doi: 10.1093/ehjcvp/pvz082. PMID: 31841131.
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Further Reading

Deshmukh US, Lundsberg LS, Culhane JF, Partridge C, Reddy UM, Merriam AA, Son M. Factors associated with appropriate treatment of acute-onset severe obstetrical hypertension. Am J Obstet Gynecol. 2021 May 20:S0002-9378(21)00559-7. doi: 10.1016/j.ajog.2021.05.012. Epub ahead of print. PMID: 34023314.
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Wilkerson RG, Ogunbodede AC. Hypertensive Disorders of Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):301-316. doi: 10.1016/j.emc.2019.01.008. PMID: 30940374.
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Cox AG, Marshall SA, Palmer KR, Wallace EM. Current and emerging pharmacotherapy for emergency management of preeclampsia. Expert Opin Pharmacother. 2019 Apr;20(6):701-712. doi: 10.1080/14656566.2019.1570134. Epub 2019 Feb 1. PMID: 30707633.
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Watson K, Broscious R, Devabhakthuni S, Noel ZR. Focused Update on Pharmacologic Management of Hypertensive Emergencies. Curr Hypertens Rep. 2018 Jun 8;20(7):56. doi: 10.1007/s11906-018-0854-2. PMID: 29884955.
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Anderson CM, Schmella MJ. CE: Preeclampsia: Current Approaches to Nursing Management. Am J Nurs. 2017 Nov;117(11):30-38. doi: 10.1097/01.NAJ.0000526722.26893.b5. PMID: 29035901.
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What factors increase successful dental care of ventilated patients?

Posted on March 4, 2021 by Sharon

Dental plaque colonization may be exacerbated in the absence of adequate oral hygiene care in critically ill, mechanically ventilated patients. Dental care is made more difficult due to the presence of the endotracheal tube, which may create:

mechanical injury of the mouth or respiratory tract
increased likelihood of dry mouth[1]

Using visual research and interviews, oral access and delivery of care for mechanically ventilated patients was analyzed, resulting in the following recommendations.

Recommendations to improve oral access and care delivery.

Dale CM, Angus JE, Sutherland S, Dev S, Rose L. Exploration of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care: A video and photographic elicitation study. J Clin Nurs. 2020 Jun;29(11-12):1920-1932. doi: 10.1111/jocn.15014. Epub 2019 Aug 20. PMID: 31342565.
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Criteria for unavoidable pressure ulcers

Posted on February 15, 2018 by Lisa

Seven articles were found that provide information on criteria for unavoidable pressure ulcers.

In order to be able to use the Find it @ Emory button within article entries to look at the full text, please use these instructions to access the collection.
1. Go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu/
2. Click on “PubMed.”
3. Copy and paste the url into the address bar of your browser: https://www.ncbi.nlm.nih.gov/myncbi/collections/54337732/?reload=updatePermissionSuccess

Vasopressor agents and development of pressure ulcers

Posted on February 15, 2018 by Lisa

Five articles were found that provide evidence on patients’ usage of vasopressor agents and subsequent development of pressure ulcers.

In order to be able to use the Find it @ Emory button within article entries to look at the full text, please use these instructions to access the collection.
Go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu/
Click on “PubMed.”
Copy and paste the url into the address bar of your browser: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/54337604/public/

Post-falls assessment tools to help in post-fall decision making in acute care settings

Posted on June 15, 2017 by Lisa

Joanna Briggs Institute (JBI) has a recommended practice entitled “Observation Following Falls in Acute Care: Older People” that is available via login with your Emory Healthcare login; search for the document by title in JBI, click “Display Results,” and then click “JBI Database PDF”: http://pid.emory.edu/h78zp

There are a variety of relevant post-falls assessment tools online:
1. Royal Devon Exeter National Health Service Foundation Trust pdf: https://tinyurl.com/yansp8t4
2. Intermountain Healthcare pdf: https://tinyurl.com/ydgxar6n
3. A Veterans Affairs Word document: https://tinyurl.com/ybvfoq2z
4. Ohio State University Medical Center pdf: https://tinyurl.com/y6usjgk8
5. South Western Ambulance Service National Health Service pdf: https://tinyurl.com/y8xqoxod

Please follow these instructions to access 8 relevant articles in PubMed.

a. Go to the Woodruff Health Sciences Center Library homepage (http://health.library.emory.edu)
b. Click on PubMed.
c. Then copy and paste this link into your browser address bar: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/52782984/public/
d. The references will appear in PubMed. Click on a reference, and you will see a Find it at Emory to the right of it which will provide availability for full text. If you are not able to access full text, you may submit citation(s) to Ask a Librarian. Library staff will get article(s) for you and email them to you.

Patient acuity tools in the hospital setting

Posted on June 2, 2017 by John

McLellan, M., & Connor, J. (n.d.). The Cardiac Children’s Hospital Early Warning Score (C-CHEWS). Journal of Pediatric Nursing., 28(2), 171-178.

Incesti, S., Bender, S., & Delunas, L. (n.d.). Development of a patient acuity model for an inpatient rehabilitation unit. Rehabilitation Nursing., 40(3), 133-138.

The Canadian Triage and Acuity Scale for children: A prospective multicenter evaluation. (n.d.). Annals of Emergency Medicine : Journal of the American College of Emergency Physicians., 60(1), Annals of emergency medicine : journal of the American College of Emergency Physicians. , 2012, Vol.60(1).

Brennan, C., Daly, B., Dawson, N., Higgins, P., Jones, K., Madigan, E., & Van Der Meulen, J. (2012). The oncology acuity tool: A reliable, valid method for measuring patient acuity for nurse assignment decisions. Journal of Nursing Measurement., 20(3), 155-185.

Lovett, R., Reardon, M., Gordon, B., & McMillan, S. (n.d.). Validity and reliability of medical and surgical oncology patient acuity tools. Oncology Nursing Forum., 21(10), 1709-1717.

Gravel, J., Manzano, S., & Arsenault, M. (n.d.). Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM : Canadian Journal of Emergency Medical Care = JCMU : Journal Canadien De Soins Médicaux D’urgence., 11(1), 23-28.

Effect of early ambulation on length of stay in ICU patients

Posted on January 20, 2015 by Lisa

When using PubMed, make sure and go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu and click PubMed or use this direct link to Emory University’s instance of PubMed: http://www.ncbi.nlm.nih.gov/pubmed?otool=emorylib. When using Emory University’s instance of PubMed, you will be able to click the Find it at Emory button within entries for articles to determine if Emory has full-text access to articles.

Here is the search technique I used:
(early ambulation OR “early mobility”) AND (critical care OR intensive care units OR icu) AND length of stay
Filters I used: meta-analysis, systematic review, English

Please paste the following search into PubMed to see 8 articles that appear to be helpful and are systematic reviews, one of the highest levels of evidence.

24424616[uid] OR 23127305[uid] OR 24222709[uid] OR 22147819[uid] OR 21164413[uid] OR 21169829[uid] OR 20048676[uid] OR 20001881[uid]

Evidence Matters

Evidence-based information for Emory

Category Archives: Critical Care