Clinical intensive care : international journal of critical & coronary care medicine
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Clin Intensive Care · Jan 1994
Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.
To relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients. ⋯ In a sample of unselected critically ill patients indices of both glucose and lipid metabolism were found to be related to the severity of illness as well as to the occurrence of sepsis and survival.
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Clin Intensive Care · Jan 1994
Case ReportsProviding psychological support for patients after critical illness.
The majority of patients have little or no memory of their stay in ICU or remember only pain, suctioning or lack of sleep. Dreams and nightmares while in the intensive care unit (ICU) and after discharge home have also been reported. The few studies investigating the longer-term psychological problems of critical illness point to a picture of social isolation with patients avoiding company and showing less affection to their partners. ⋯ Two case histories give an illustration of the type of problems ICU patients experience during their recovery and how an informal support group can help. In addition to possible benefits to the patients, support groups can also give ICU staff a chance to understand the process of recovery from critical illness and to examine the effects on patients of their own practice. However, they must also have enough insight to know when a patient needs professional help; for example, a patient displaying symptoms of post-traumatic stress disorder should be referred, with their agreement, to a clinical psychologist.
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Clin Intensive Care · Jan 1994
Comparative StudyContinuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system.
We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. ⋯ These larger than anticipated limits of agreement may not reflect any inaccuracy in the continuous measurement system, rather they may highlight the extent of well recognised potential errors inherent in the intermittent bolus technique. The availability of a system to measure cardiac output continuously provides a major improvement in intensive care monitoring. This system will permit the rapid and accurate assessment of the response of patients to therapy while providing increased diagnostic facilities and a new research tool.
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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.