Clinical intensive care : international journal of critical & coronary care medicine
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The transition from mechanical ventilation to spontaneous breathing in the intensive care unit is a two-stage process: weaning and extubation. Certain parameters require consideration before the commencement of weaning, namely respiratory function (both pulmonary gas exchange and respiratory muscle strength), cardiovascular status, stability of clinical condition, low metabolic demands, psychological factors and, possibly, patient collaboration. Appropriate sedation is crucial for successful weaning to keep the patient rested and to maintain the oxygen consumption and carbon dioxide production low. ⋯ This transition may be considered to comprise two separate stages, namely weaning and extubation. Weaning consists of preparation for spontaneous breathing supported and monitored by a mechanical ventilator and attendant monitoring of all the important vital parameters, while extubation marks the final switch to unsupported spontaneous breathing, which may be quite a big step for the patient. Important weaning parameters.
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Clin Intensive Care · Jan 1994
ReviewA multi-disciplinary approach to families of brain dead children.
To relate our multi-disciplinary approach to families of brain dead children. ⋯ Our multi-disciplinary approach may assist clinicians and other health care providers in successfully dealing with families of brain dead children.
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Clin Intensive Care · Jan 1994
Review Comparative StudyPressure controlled ventilation--a true advance?
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Clin Intensive Care · Jan 1994
The value of serum C-reactive protein levels as a marker of sepsis in intensive care unit patients.
A one-year prospective study was carried out to assess the value of routine serum C-reactive protein (CRP) measurement in the early diagnosis of infection in ICU patients of a District General Hospital. Ninety-one patients were included in the study. Sixty-eight patients yielded 28 proved and 77 suspected episodes of infection. ⋯ The only significant rises in CRP (> 25%) were found in the suspected infection group from the day before to the day of infection, when compared with controls (p = 0.04). Traditional markers of infection--maximum temperature and peripheral white blood cell count--were significantly associated with infection. Maximum temperature was significantly higher in both proved and suspected infection on the day before infection (p = 0.000 and 0.001), and on the day of infection (p = 0.025 and 0.03), compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Sedation in the intensive care unit (ICU) aims to improve patient comfort and facilitate treatment procedures. Most units still rely on a combination of opioid and benzodiazepines with the addition of other drugs for specific requirements. However, the effect of sedative agents in critically ill patients is often unpredictable, so frequent assessment of the depth of sedation is essential to match the depth to patient requirements. ⋯ The technique may not be suitable for a large number of patients, particularly early in their ICU stay but, for long-term sedation and in the weaning phase--of sedation as well as ventilation--the utility of a drug delivery system truly controlled by the patient should be further explored. The ICU has been succinctly described as an environment in which 'anxiety is prevalent, pain frequent, rest difficult and sleep impossible'. Sedation in the ICU has the double objective of relieving patient distress as well as facilitating treatment procedures.(ABSTRACT TRUNCATED AT 250 WORDS)