Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2001
ReviewA review of neuromuscular blockade in the critically ill patient.
The continuous administration of neuromuscular blocking agents is thought to be associated with a number of adverse effects and complications, including post-paralytic syndrome (characterized by persistent paralysis), muscle weakness, and the inability to wean from the ventilator despite discontinuation of the therapy. Consequently, clinical objectives emphasize administering only the dose necessary to optimize the effect of the drug and for the shortest possible time. This article provides an overview of the administration of neuromuscular blocking agents, from the perspective of a critical care pharmacist and critical care nurses. The complexities associated with pharmacological paralysis in critically ill patients warrants the comprehensive approach to care that multidisciplinary team members can provide.
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Dynamics (Pembroke, Ont.) · Jan 2001
Randomized Controlled Trial Clinical TrialCost analysis of an intensive home follow-up program for first-time post-myocardial infarction patients and their families.
The general goal of this research was to determine the effectiveness of a home follow-up program in order to acquire guidance in how to plan the future structure and contents of post-myocardial infarction (MI) patients' care and rehabilitation. The specific aim of this study was to evaluate the cost-effectiveness of the program in reducing the rate of rehospitalization of first-time post-MI patients when measured at six weeks and six months post-discharge. ⋯ Intensive home follow-up provided a cost-effective alternative to traditional cardiac rehabilitation programs; however, a larger study is required to assess the generalizability of the results and long-term cost effectiveness.
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Continuous renal replacement therapy is a treatment option that is especially suited to the critical care setting. Greater hemodynamic stability, the ongoing ability to optimize fluid balance, and the potential for clearing inflammatory mediators are among the frequently cited advantages continuous veno-venous dialysis modalities offer over traditional intermittent therapies. ⋯ The blood is then returned to the patient, without large fluctuations in electrolyte and acid-base balance or renal hypoperfusion. This article includes a review of acute renal failure, a discussion of the indications for continuous renal replacement therapy, the mechanisms of action of this therapy, and the nursing considerations.
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Widespread acceptance of the importance of discontinuing ventilator support at the earliest possible opportunity has resulted in a number of efforts to develop a standardized approach to extubation. The implementation of an extubation protocol designed for the medical/surgical intensive care unit of a university-affiliated hospital followed a series of educational sessions that were open to all members of the multidisciplinary team. ⋯ A clinical outcome was defined as the percentage of patients who required reintubation within 48 hours. The protocol has been well-received by the ICU team and has become an established component of ventilator management.