BACKGROUND: Critical care practitioners are searching for ways to improve the quality and outcomes of care while decreasing cost and length of stay. One technological advance that may facilitate meeting these objectives is bedside or point-of-care laboratory equipment. Evaluation of point-of-care testing for application in each institution requires information about the devices available; knowledge of the advantages and disadvantages of the technologies, the clinical impact, and cost of the process change; and strategies for successful implementation. OBJECTIVES: To review the literature on point-of-care testing and the experience of healthcare professionals who have already successfully implemented this type of testing. METHODS: A total of 81 relevant published articles were reviewed, and 21 critical care units in 8 facilities that use point-of-care testing were visited. Open-ended interviews were conducted with 83 subjects: 56 nurses, 14 laboratory personnel, 9 respiratory therapists, and 4 others. CONCLUSIONS: Point-of-care testing is a technological innovation with the potential for improving patients' care without increasing costs. It most likely will soon become part of the standard of care.
Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. Although the adverse effects of agitation are well-known, their impact on morbidity, mortality, length of stay, and cost are only beginning to be addressed. Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.