Journal of critical care
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Journal of critical care · Dec 2009
ReviewState of the art: sedation concepts with volatile anesthetics in critically Ill patients.
The use of volatile anesthetics in the intensive care unit (ICU) has only been possible at great cost with the use of commercially available anesthesia systems. A new anesthetic-conserving device (AnaConDa) now facilitates, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients as part of prolonged sedation, using ICU ventilators. The volatile anesthetic is hereby applied continually via a syringe pump into a miniature vaporizer, which is integrated into the ventilator circuit in place of the usual respiratory filter. ⋯ Aside from the possibility of using a central anesthetic gas scavenging system, the use of special passive residual gas filters, which can be connected to the expiratory outlet of the respirator machine, appears above all to be practical. The use of volatile anesthetics on the ICU could adopt a permanent position in various intensive care analgosedation concepts in future. It may be possible thereby to optimize the treatment process both in medical and economical terms.
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Delirium is common but underdiagnosed in critical care units, which results in increased morbidity and mortality. This study aimed to evaluate the reliability and validity of diagnosing delirium with the Memorial Delirium Assessment Scale (MDAS) in India. ⋯ Our findings suggest that training junior residents to use a brief screening instrument to diagnose delirium is a reliable and valid option in resource-poor critical care settings.
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Journal of critical care · Dec 2009
A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients.
Although no ideal sedative exists, dexmedetomidine is unique because it produces sedation and analgesia without decreasing the respiratory drive. Hemodynamic responses to dexmedetomidine are variable and dependent on the patient population. Our initial experience was associated with an unacceptable incidence of hypotension and bradycardia. We evaluated occurrence of hypotension and bradycardia in critically ill surgical patients receiving dexmedetomidine before and after implementation of a dosing protocol. ⋯ We found that use of a protocol that increases the time interval between dosage adjustments may reduce dexmedetomidine-associated hypotension.
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Journal of critical care · Dec 2009
Age bias in clinical trials in sepsis: how relevant are guidelines to older people?
Severe sepsis has a high mortality, and both incidence and mortality increases with increasing age. In recent years, several specific therapies have been recommended by guidelines to reduce mortality in severe sepsis. ⋯ Specific evidence of benefit in the elderly is present regarding treatment with activated protein C and ventilatory strategies. In view of the pharmacokinetic and pharmacodynamic differences in older people, and the higher incidence of comorbidity in the elderly, there is a need for clinical trials in severe sepsis to specifically include older patients.
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Journal of critical care · Dec 2009
Comparative StudyDopamine therapy in septic shock: detrimental effect on survival?
The aim of this study is to examine the potential impact of dopamine therapy on 28-day mortality in adult septic shock. ⋯ In our cohort study, dopamine use was linked to mortality as compared to other vasopressor therapies, particularly in patients with essential hypertension. Future randomized studies attempting to compare dopamine with other therapies in septic shock should pay attention to patients with essential hypertension.