Critical care medicine
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Critical care medicine · Jun 1994
Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit.
To describe the variety of medications prescribed along with the doses administered and routes of administration, and to delineate the clarity of orders written and the accuracy of transcription of drugs used for sedation, anxiety, pain, and neuromuscular blockade in a surgical intensive care unit (ICU). ⋯ A wide variety of sedatives and analgesics are frequently used in surgical ICU patients. These agents are often ordered on an "as-needed" basis using a range of doses, sometimes without adequate directions about the indication for their use. Daily doses received are significantly less than their maximum allowable daily doses. Orders for these medications are sometimes transcribed and charted incorrectly. In contrast, neuromuscular blocking agents are not commonly prescribed. Future studies are needed to improve order writing of these agents, and to determine the criteria used by physicians and nurses in the selection and administration of these agents, the outcomes of therapy, and the most cost-effective regimen.
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Critical care medicine · Jun 1994
Comparative Study Clinical Trial Retracted PublicationCardiopulmonary actions of intravenously administered enalaprilat in trauma patients.
To determine the cardiopulmonary actions of the intravenous administration of the angiotensin-converting enzyme inhibitor enalaprilat in hypertensive trauma patients. ⋯ The intravenous administration of enalaprilat successfully decreased blood pressure in most of our patients. Mechanisms other than the renin-angiotensin system also appear to be involved in hypertensive, critically ill patients. Pulmonary function was not altered; right ventricular function, and both oxygen consumption and oxygen delivery improved in the enalaprilat responder group. Thus, the availability of intravenous enalaprilat seems to enlarge our armamentarium for treating hypertension in the critically ill patient.
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Critical care medicine · May 1994
ReviewProlonged paralysis in intensive care unit patients after the use of neuromuscular blocking agents: a review of the literature.
To review the reports of prolonged neuromuscular blockade secondary to vecuronium and atracurium administration. To propose mechanisms for prolonged blockade, as well as methods to avoid prolonged blockade. ⋯ Controlled studies assessing the appropriate drug, administration method, use of drug in end-organ dysfunction, and monitoring techniques are unavailable. From the available case reports, length of neuromuscular blockade has been associated with end-organ dysfunction, concomitant drug use, severity of the underlying illness, length of therapy, monitoring techniques used, and perhaps method of drug administration. Steroidally based neuromuscular blocking agents may be particularly hazardous in patients receiving systemic corticosteroids. It is premature to determine the safety of one particular neuromuscular blocking drug in relation to another. Further studies are needed to optimize the use and safety of neuromuscular blocking agents in intensive care unit patients.