Critical care medicine
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Critical care medicine · Mar 2006
Randomized Controlled Trial Multicenter Study Comparative StudyA comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients.
Fenoldopam mesylate is a selective dopamine-1 agonist, with no effect on dopamine-2 and alpha1 receptors, producing a selective renal vasodilation. This may favor the kidney oxygen supply/demand ratio and prevent acute renal failure. The aim of the study was to investigate if fenoldopam can provide greater benefit than low-dose dopamine in early renal dysfunction of critically ill patients. ⋯ In critically ill patients, a continuous infusion of fenoldopam at 0.1 microg/kg/min does not cause any clinically significant hemodynamic impairment and improves renal function compared with renal dose dopamine. In the setting of acute early renal dysfunction, before severe renal failure has occurred, the attempt to reverse renal hypoperfusion with fenoldopam is more effective than with low-dose dopamine.
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Critical care medicine · Mar 2006
ReviewDecision tools for life support: a review and policy analysis.
To identify, describe, and compare published documents intended to guide decisions about the administration, withholding, or withdrawal of life support in critical care. ⋯ Published tools for guiding life-support decisions vary widely in their genesis, authorship, format, focus, and practicality. They also differ in their attention to, and positions on, key life-support dilemmas. Future research on decision tools should focus on how users interpret and apply the messages in these tools and their impacts on practice, quality of care, participant experiences, and outcomes.
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Critical care medicine · Mar 2006
ReviewCritical care nursing: workforce issues and potential solutions.
To review the history and development of critical care nurses, the supply and demand issues related to critical care nursing, critical care nursing's contribution to patient outcomes, and recommendations to ensure a steady and strong workforce. ⋯ Critical care nurses are an essential and vital aspect of the critical care team. Nurses contribute to improved patient outcomes, reduced morbidity and mortality, reduced complications and errors, and reduced overall costs. More than 400,000 nurses practice in critical care, and additional opportunities exist and will develop. The challenge is to ensure an adequate supply of appropriately trained staff.
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Critical care medicine · Mar 2006
Randomized Controlled Trial Comparative StudyEfficiency of oxygen administration: sequential gas delivery versus "flow into a cone" methods.
Fio2 values of a new oxygen mask that exploits efficiencies afforded by sequential gas delivery (SGD) were compared to those of a nonrebreathing mask (NRM) and a Venturi oxygen mask. ⋯ We conclude that SGD can be exploited to provide FIO2>0.95 with oxygen flows as low as 8 L/min, as well as accurate and efficient dosing of oxygen even in the presence of hyperpnea.
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Critical care medicine · Mar 2006
ReviewTeam model: advocating for the optimal method of care delivery in the intensive care unit.
To review published data on the team model of intensive care unit (ICU) care delivery. ⋯ Current and looming shortages of all ICU healthcare providers is a barrier to universal implementation of the team model. Advocating for the ICU team model for critical care delivery requires local, regional, national, and international activities for success.