This article provides a broad overview of pulmonary hypertension, including classifications, risk factors, signs and symptoms, diagnosis, and treatment options. Nursing considerations and optimization of hemodynamic values in patients with pulmonary hypertension in a critical care unit are reviewed through the lens of a case study. Preventing decompensation is essential in the successful care of these patients.

Interest in the right ventricle has increased because of advances in pulmonary hypertension treatment, improved diagnostic technology, and increased implantation of left ventricular assist devices and other mechanical circulatory assist devices. Right ventricular dysfunction is an independent predictor of mortality in patients with chronic heart failure. The purpose of this article is to describe the normal structure and function of the right ventricle, causes of right ventricular dysfunction leading to right ventricular failure, diagnostic hemodynamic assessments, and management of right ventricular failure in the critical care unit.

In Brief Pulmonary arterial hypertension is a rare and progressive disease associated with high pulmonary vascular pressures leading to right ventricular failure and death. The exact incidence is unknown. This article provides a broad overview of the disease, including pathophysiology, risk factors, management guidelines, and pharmacologic therapies. Nursing considerations are discussed, with an emphasis on the continuum of care. Pulmonary arterial hypertension is a rare and progressive disease that leads to right ventricular failure and death. This article examines the pathophysiology, risk factors, management guidelines, pharmacologic therapies, and nursing considerations associated with this disease.

In recent years, the use of extracorporeal membrane oxygenators (ECMO) has proliferated in cardiovascular intensive care units (ICUs) partially due to advances in technology with the development of smaller, more portable machines, and the increasing numbers of patients with end-stage heart failure and cardiogenic shock. The use of ECMO has been found to improve survival rates in this deadly situation. Due to higher volumes of patients requiring ECMO, additional qualified resources for providing ECMO services may be necessary. The purpose of this article was to review cardiogenic shock etiologies, the role of ECMO, and to discuss the transition process of implementing a nurse-run ECMO program.

Patients undergoing a lateral thoracotomy for pulmonary resection have moderate to severe pain postoperatively that is often treated with opioids. Opioid side effects such as respiratory depression can be devastating in patients with already compromised respiratory function. This prospective double-blinded clinical trial examined the analgesic effects and safety of a dexmedetomidine infusion for postthoracotomy patients when administered on a telemetry nursing floor, 24 to 48 hours after surgery, to determine if the drug's known early opioid-sparing properties were maintained. Thirty-eight thoracotomy patients were administered dexmedetomidine intraoperatively and overnight postoperatively and then randomized to receive placebo or dexmedetomidine titrated from 0.1 to 0.5 μg·kg·h(-1) the day following surgery for up to 24 hours on a telemetry floor. Opioids via a patient-controlled analgesia pump were available for both groups, and vital signs including transcutaneous carbon dioxide, pulse oximetry, respiratory rate, and pain and sedation scores were monitored. The dexmedetomidine group used 41% less opioids but achieved pain scores equal to those of the placebo group. The mean heart rate and systolic blood pressure were lower in the dexmedetomidine group but sedation scores were better. The mean respiratory rate and oxygen saturation were similar in the two groups. Mild hypercarbia occurred in both groups, but periods of significant respiratory depression were noted only in the placebo group. Significant hypotension was noted in one patient in the dexmedetomidine group in conjunction with concomitant administration of a beta-blocker agent. The placebo group reported a higher number of opioid-related adverse events. In conclusion, the known opioid-sparing properties of dexmedetomidine in the immediate postoperative period are maintained over 48 hours.

The United States continues to have a prevailing public health problem related to disparities in healthcare. Factors contributing to disparities include ethnicity, gender, socioeconomic status, educational level, geographic location, and hospital characteristics. In cardiovascular care, gaps in care have been associated with lack of conformity to evidence-based therapies known to improve clinical outcomes, including survival, quality of life, and freedom from rehospitalization. Specifically, there are disparities in use of a number of cardiovascular life-saving procedures including cardiac catheterization, percutaneous coronary intervention, coronary artery bypass surgery, and implantation of defibrillators and cardiac resynchronization devices. The purpose of this article was to illustrate the range of disparities that exist in relation to management of patients with acute coronary syndromes, interventional cardiology procedures, cardiac surgery, heart failure, and device implantation. Because the impact on patient outcomes is high, potential interventions to address disparities will be provided.

Cardiovascular disease affects 82.6 million Americans and represents a tremendous financial burden for individuals as well as the country. Acute coronary syndrome (ACS), one component of cardiovascular disease, impacts more than 17 million Americans annually. ACS comprises a spectrum of atherosclerosis including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Early recognition, early treatment, decreasing risk factors, and secondary prevention decrease mortality. This article describes the spectrum of ACS, management of ACS, and secondary prevention strategies.

Inpatient glucose control today is complex and challenging for the clinician. The importance of avoiding wide swings in the BG levels and hypoglycemic events cannot be underestimated. Nurses must be at the table as insulin protocols or physician order sets are being developed to address issues with readability and understanding. Education of all staff is extremely important with follow-up education at intervals for both nurses and physician providers. While there are no official guidelines for quality of inpatient glycemic control, a multidisciplinary team consisting of key physicians (endocrinology and others), clinical nurse specialists, and diabetes educator and clinical pharmacist can develop quality improvement projects for monitoring and process improvement. Continuous monitoring of practices will reduce the risk for errors and support safe practices.

Survival rates associated with in-hospital cardiac arrest remain stagnant in spite of recent advances in technology. The purpose of this article is to provide a review of the recent literature addressing in-hospital cardiac arrest outcomes and factors that may play a role affecting the outcomes. Recent recommendations demonstrating potential for improved outcomes are discussed.

Obesity has become a major health problem in the United States and is well known to be a risk factor for the development of cardiovascular disease. Many clinicians perceive obesity, particularly severe or morbid obesity, to be associated with increased risk for mortality and morbidity following coronary artery bypass graft (CABG) surgery. This article provides a review of the literature related to mortality and morbidity, including the impact of diabetes, risk for acute respiratory failure, and sternal wound infection associated with obese patients undergoing CABG surgery. Implications for nursing practice are addressed with recommendations for practice in this patient population.

Coronary artery bypass graft (CABG) reoperation carries an increased risk for mortality and other complications when compared with the risks and complications associated with the initial operative procedure. The purpose of this article is to describe the incidence of repeat CABG surgical procedures, risk factors, associated outcomes, and important considerations for nursing practice.

Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.

Continuous ST-segment monitoring has been shown to be beneficial for patients with acute coronary syndromes as well as for other patients in the intensive care unit (ICU). This article reviews the significance and value of continuous ST-segment monitoring with emphasis on the value of 12-lead ST-segment monitoring across the continuum of care from the emergency department, to the cardiac catheterization laboratory, the ICU, and the telemetry unit.