Intensive care medicine
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To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different demographic variables. ⋯ Interventions should be aimed at relieving the patient's pain and at controlling the level of noise to make sleep possible. From the psychological standpoint, the independence of the patient should be encouraged, thus stimulating the recovery of self-control. The team should also inform the patient about the procedures which will be carried out.
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Intensive care medicine · Dec 1997
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialRight ventricular function during weaning from mechanical ventilation after coronary artery bypass grafting: effect of volume loading.
The study was designed to investigate the right ventricular (RV) reaction to weaning from mechanical ventilation (MV) in patients with and without volume loading after coronary artery bypass grafting (CABG). ⋯ An increase in RV volumes with a concomitant increase in RVSWI was observed in high preload patients when going from MV to SV, suggesting a preserved RV function during weaning from MV in this group compared with control patients. The depression in RV contractility observed in some patients suggested that rapid volume expansion before weaning from MV in CABG patients must be done carefully.
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Intensive care medicine · Dec 1997
Practice Guideline GuidelineUK guidelines for the use of inhaled nitric oxide therapy in adult ICUs. American-European Consensus Conference on ALI/ARDS.
Although unlicensed, inhaled nitric oxide (NO) therapy is now widely used in the United Kingdom. Our aim was to produce guidelines for the clinical application of inhaled NO in adult intensive care practice, based upon the current level of published information. ⋯ The need for additional quality research to establish evidence of efficacy and safety was emphasized. The guidelines are designed to act within the context of current practice and knowledge and should be revised as further data emerge.
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Intensive care medicine · Dec 1997
Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study.
To evaluate the incidence, clinical features, and prognosis of pulmonary complications associated with toxic epidermal necrolysis ⋯ "Specific" involvement of bronchial epithelium was noted in 27% of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.
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Intensive care medicine · Dec 1997
The difference between withholding and withdrawing life-sustaining treatment.
First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction. ⋯ We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.