Critical care clinics
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Acute pain management in critically ill ICU patients is an area that needs increased attention. Modern techniques exist that can help speed recovery and reduce duration of ICU and, potentially, hospital stay. Application of contemporary knowledge in this area benefits both clinician and patient.
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Critical care clinics · Oct 1994
ReviewNonpharmacologic management of patient distress during mechanical ventilation.
Patients on mechanical ventilators experience distress related to the endotracheal tube, the critical care environment, and the critical illness. The strategies suggested here to limit distress--therapeutic relationship building and communication, cognitive-behavioral therapies, and contracted family visiting--all can be implemented by critical care providers. A growing research base documents the success of these interventions in intubated patients.
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The critical care unit is a place where multiple organ system failure can be effectively reversed by highly technologic treatment innovations. That same technology can confer a great deal of stress on the patient, leading to the unique syndrome of integrative brain failure. Exacerbating factors, such as pain, anxiety, and discomfort, can ultimately result in severe agitation syndromes. This article outlines uniquely specialized treatments for these syndromes and the outlook for future therapies.
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Critical care clinics · Oct 1994
ReviewPharmacology of neuromuscular blocking agents in the intensive care unit.
In critically ill patients, organ function, blood flow, and caregiving personnel change constantly. The risks inherent in paralyzing a patient, such as those of positioning (nerve injuries, stasis injuries) and ventilator disconnection are compounded by the duration of paralysis in the ICU. When used with attention to the pharmacologic properties, patient organ function, and cost, however, muscle relaxants are a useful adjunct to ICU management.
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Critical care clinics · Oct 1994
ReviewOverview of improving tolerance of long-term mechanical ventilation.
In summary, advances in critical care and mechanical ventilation have resulted in an increased salvage of critically ill patients, a number of whom require long-term ventilation as a means of life support. In addition, the total number of patients receiving long-term ventilation has increased dramatically over the past couple of years, and they now are treated in many different locations throughout the health care delivery system (the intensive care unit, general medical floor, specialized weaning units, and the home). Moreover, patients who require long-term ventilation usually suffer from a complex blend of medical, physiologic, and psychological disorders that may impair tolerance of chronic ventilation. Careful evaluation and systematic treatment of psychological, medical, and physiologic disorders, coupled with optimized ventilator settings, may improve patients' tolerance and maximize their functional capacity.