AACN clinical issues
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AACN clinical issues · Apr 2004
ReviewMalignant hyperthermia: pathophysiology, clinical presentation, and treatment.
Malignant hyperthermia (MH) was first described as an inherited highly lethal disorder in 1960. There has since been significant progress in the clinical management, identification of MH susceptible (MHS) persons, and understanding of the underlying pathophysiology. When patients are known to be MHS prior to surgery, an MH episode can easily be avoided by the use of safe nontriggering anesthetic agents. ⋯ MH is triggered in humans by an MH triggering anesthetic agent, which causes the release of calcium from the sarcoplastic reticulum of the skeletal muscle cell at an uncontrolled rate resulting in a hypermetabolic state. Recent molecular genetic studies have shown that MH is related to an abnormal ryanodine receptor that controls the release of calcium from the sarcoplastic reticulum. This article reviews the current understanding of the pathophysiology, diagnosis, clinical presentation, and treatment of MH.
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AACN clinical issues · Jan 2004
Clinical Trial Controlled Clinical TrialThe impact of bispectral index monitoring on rates of propofol administration.
The purpose of this article is to examine the efficacy of Bispectral Index (BIS) monitoring as a tool for adjusting the amount of propofol patients receive to maintain a safe and adequate level of sedation in a neurocritical care setting. The BIS monitor is utilized as an adjunct for anesthesia monitoring in the operating room setting and is currently being investigated as a tool for objective sedation monitoring in the critical care setting. 1-6 Sedation is discussed in terms of patient safety and comfort. ⋯ Data were abstracted from a quality improvement study of propofol use adjusted to BIS values in patients whose sedation levels were previously adjusted to a goal Ramsay score. The results suggest that there are potential benefits to incorporating BIS into routine sedation assessment in the neurocritical care setting.
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AACN clinical issues · Jan 2004
Review Case ReportsThe puzzle of sepsis: fitting the pieces of the inflammatory response with treatment.
Sepsis is a complex syndrome characterized by simultaneous activation of inflammation and coagulation in response to microbial insult. These events manifest as systemic inflammatory response syndrome (SIRS)/sepsis symptoms through release of proinflammatory cytokines, procoagulants, and adhesion molecules from immune cells and/or damaged endothelium. Conventional treatments have focused on source control, antimicrobials, vasopressors, and fluid resuscitation; however, a new treatment paradigm exists: that of treating the host response to infection with adjunct therapies including early goal directed therapy, drotrecogin alfa (activated), and immunonutrition. ⋯ Therapies targeting improved oxygen and blood flow and reduction of apoptosis and free radicals are under investigation. Early sepsis diagnosis through detection of pro calcitonin, C reactive protein, sublingual CO2, and genetic factors may be beneficial. Ultimately, intervention timing may be the most important factor in reducing severe sepsis mortality.
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AACN clinical issues · Jan 2004
ReviewInsulin resistance and hyperglycemia in critical illness: role of insulin in glycemic control.
Alterations in glucose metabolism, including hyperglycemia associated with insulin resistance, occur in critical illness. Acutely, such alterations result from normal, adaptive activation of endocrine responses, including increased release of catecholamines, cortisol, and glucagon and a reduced glucose uptake capacity. In prolonged critical illness, neuroendocrine changes lead to more extensive metabolic changes that may be associated with development of complications and poor prognosis. ⋯ Although the mechanisms for improved patient outcomes need to be established, this novel approach to management of hyperglycemia in critical illness is a new and important concept for those working in critical care. This article reviews alterations in glucose metabolism which occur in critically ill patients and discusses potential mechanisms and mediators (e.g., hormones, cytokines) that may play a key role in hyperglycemia and insulin resistance during acute and prolonged phases of severe illness. The article addresses the application of insulin protocols and exogenous regulation of glucose concentration in critical illness based on a review of recent intervention studies.
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AACN clinical issues · Jan 2004
ReviewSevere acute respiratory syndrome: another challenge for critical care nurses.
Severe acute respiratory syndrome (SARS) is a viral disease that may be contracted by exposure to a newly recognized form of the coronavirus. It often manifests through a set of common respiratory symptoms that include fever and nonproductive cough. To date, SARS has no vaccine or definitive treatment. ⋯ Intensive care unit (ICU) nurses and other healthcare workers who care for SARS patients are at risk of contracting the disease. Thus, it is important that ICU nurses be familiar with the disease and its implications for critical care. This article provides critical care nurses with an update on the first SARS outbreak, its origin, case definition, clinical manifestations, diagnosis, relevant infection control practices, management, and recommendations for the role of ICU nurses in dealing with future outbreaks.