Clinical intensive care : international journal of critical & coronary care medicine
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Clin Intensive Care · Jan 1994
Metabolic effects of continuous veno-venous haemofiltration in critically ill patients.
To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF). ⋯ CVVH does not affect metabolic rate and haemodynamic stability in critically ill patients. The lack of any effect on the metabolic rate and haemodynamic parameters in such patients may have significant clinical importance and it further attests to the suitability of CVVH for the treatment of critically ill patients.
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Clin Intensive Care · Jan 1994
Comparative StudyPrevention of atmospheric contamination during isoflurane sedation.
With a view to minimising staff exposure to exhaled isoflurane which had been used for sedation, we assessed the efficacy of either activated charcoal adsorption or active or passive mechanical scavenging systems in intensive care units (ICUs). Personal monitoring revealed minimal exposure of staff to the sedating agent. ⋯ The activated charcoal adsorbers functioned highly efficiently for at least 12-hour periods. With simple scavenging techniques, atmospheric isoflurane contamination during sedation with the agent remains well within an acceptable range and is unlikely to pose a health risk to nursing and medical staff.
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Chest tubes are placed to empty the pleural space of air or fluid which prohibits full lung expansion. The function of these tubes is dependent on adequate placement, effective drainage and frequent re-evaluation of the patient and the chest drainage system. Knowledge of the principles of chest tube drainage is important to evaluate adequately the function of a tube thoracostomy.
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Clin Intensive Care · Jan 1994
ReviewNew horizons in ICU sedation: exploring non-sedative effects of ICU sedation.
Sedative drugs are widely used in intensive care, primarily in ventilated patients. The common actions and side-effects of these agents are widely recognised. However, recent evidence suggests that opiates and other sedative agents that are used in this situation also have important, but not widely appreciated, effects on metabolism, physiological signalling and disease mechanisms. ⋯ First, they provide explanations for some phenomena observed during their use. Second, some of the undesirable side-effects may be avoided by judicious use of drugs in certain clinical situations. Finally, there is the prospect that we may be able to harness some actions for novel therapeutic purposes.
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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.