Critical care medicine
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Critical care medicine · Jan 2004
Comparative StudyCurrent opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.
Recently published clinical practice guidelines of the Society of Critical Care Medicine recommend monitoring for the presence of delirium in all mechanically ventilated patients because of the potential for adverse outcomes associated with this comorbidity, yet little is known about healthcare professionals' opinions regarding intensive care unit delirium or how they manage this organ dysfunction. The aim of this survey was to assess the medical community's beliefs and practices regarding delirium in the intensive care unit. ⋯ Most healthcare professionals consider delirium in the intensive care unit a common and serious problem, although few actually monitor for this condition and most admit that it is underdiagnosed. Data from this survey point to a disconnect between the perceived significance of delirium in the intensive care unit and current practices of monitoring and treatment.
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Critical care medicine · Jan 2004
ReviewVentilatory management of acute respiratory distress syndrome: a consensus of two.
To synthesize the emerging body of experimental, observational, and clinical trial data into a practical guideline for safe and effective ventilatory management of acute respiratory distress syndrome. ⋯ Prevention of ventilator-induced lung injury while accomplishing the essential life-supporting roles of mechanical ventilation is a complex undertaking that requires application of principles founded on a broad experimental and clinical database and on the results of well-executed clinical trials. At the bedside, execution of an effective lung-protective ventilation strategy remains an empirical process best guided by integrated physiology and a readiness to revise the management approach depending on the individual's response.
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Critical care medicine · Jan 2004
Practice Guideline Comparative Study GuidelineGuidelines for critical care medicine training and continuing medical education.
Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. This should be accomplished in an environment dedicated to compassionate and ethical care. ⋯ Guidelines for the continuum of education in critical care medicine from residency through specialty training and ongoing throughout practice will facilitate standardization of physician education in critical care medicine.
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Critical care medicine · Jan 2004
Comparative StudyEarly enteral nutrition in mechanically ventilated patients in the prone position.
To assess the tolerance of early enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position. ⋯ In critically ill patients receiving invasive mechanical ventilation in the prone position, early enteral nutrition is poorly tolerated. Prokinetic agents or transpyloric feeding and semirecumbency should be considered to enhance gastric emptying and to prevent vomiting in patients receiving mechanical ventilation in the prone position.
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Critical care medicine · Jan 2004
Comparative StudyEndotracheal tube intraluminal volume loss among mechanically ventilated patients.
To measure endotracheal tube intraluminal volume loss among mechanically ventilated patients. ⋯ Endotracheal tube intraluminal volume loss is common among patients with acute respiratory failure requiring mechanical ventilation and increases with prolonged tracheal intubation.