Heart & lung : the journal of critical care
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The delirium that is commonly associated with admission to an intensive care setting (intensive care unit [ICU] psychosis) may be terrifying to the patient, but may go undetected by the nurse. Our current understanding of this delirium is discussed according to incidence, defining characteristics, and etiologic or contributing factors such as predisposing patient factors, pharmacologic agents, and environmental factors. ⋯ These episodes of delirium are examined with reference to sensory-perceptual, perceptual or sensory alterations. We discuss nursing interventions that help to prevent or lessen the impact of delirium before an ICU admission, during the ICU course, and after discharge from the ICU.
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In a prospective study, the intensity of extrapyramidal symptoms (EPS) was rated in two groups of delirious, medically ill patients. Fourteen patients received intravenous (IV) haloperidol and benzodiazepines for control of severe agitation and four received IV haloperidol alone. Patients were rated daily by a standardized scale for EPS by raters blind to the dose of haloperidol and benzodiazepines. ⋯ In the haloperidol and benzodiazepine group there were only one case of very mild parkinsonian-like EPS and no cases of akathisia or dystonia. No adverse respiratory or cardiac reactions were seen in any patients. The literature on the use of IV haloperidol alone and in combination with benzodiazepines is briefly reviewed and possible explanations of the lower intensity of EPS with IV haloperidol in combination with benzodiazepines are discussed.
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Comparative Study
Diagnostic accuracy of fever as a measure of postoperative pulmonary complications.
Various prevalence rates have been estimated for pulmonary complications after abdominal surgery, and fever has been thought to be a diagnostic indicator. This study quantifies the diagnostic accuracy of fever as a measure of postoperative pulmonary complications and includes the sensitivity, specificity, and positive and negative predictive values. Assessments using fever and chest x-ray film were determined for 270 patients after elective intra-abdominal surgery in three hospitals with six practicing surgeons in a Southern Ontario city. ⋯ The sensitivity and negative predictive value of fever were slightly below 50%, and the specificity and positive predictive value of fever was 68% and 66% respectively. Fever was an accurate indicator of x-ray evidence of atelectasis in only 56% of the subjects. Therefore, neither the presence nor the absence of fever can assure clinicians of the presence or absence of a postoperative pathologic pulmonary complication such as atelectasis.
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Comparative Study
Use of fiber-optic pressure transducer for intracranial pressure measurements: a preliminary report.
Invasive monitoring of intracranial pressure (ICP) is becoming the standard of care for management of acute neurologic and neurosurgical patients. As a result of improved fiber-optic technology, a new disposable 4 French fiber-optic transducer-tipped catheter (FTC) has been introduced for facilitating measurement of intracranial pressure. Placement of the FTC can be intraventricular, subarachnoid, subdural, or intraparenchymal. ⋯ Pressure recordings tracked well except during transient periods of increased ICP, when FTC showed higher peak pressures. Use of the FTC requires education regarding placement and maintenance techniques. Although staff experience with the catheter can practically eliminate the problem, the FTC catheters need special handling because of potential for fiber breakage.