Articles: patients.
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In the research reported, 298 patients were asked to describe their memories of the Royal Melbourne Hospital's intensive care unit (ICU). The data were collected by either self-reported questionnaires or structured interviews and examined from a bio-psycho-social perspective using both qualitative and quantitative methods. These recollections demonstrate that the close surveillance by both technological support and health care practitioners provide many patients and their families with a feeling of safety. ⋯ The data indicate that while patients found the presence of good communication in ICU both therapeutic and reassuring, they found the lack of good communication distressing. Poor communication not only caused anxiety while the patient was in ICU but also contributed to less than optimal recoveries after discharge. Finally, it will be argued that the provision of information from nurses not only diminished feelings of anxiety but also empowered patients to become involved in decisions about their care.
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To review the pathophysiology of gastroparesis and present a practical approach to the management of this disorder in the critically ill patient. ⋯ Gastric dysmotility is common in the critically ill patient. However, treatment of the underlying conditions leading to gastroparesis and the introduction of prokinetic agents will allow the majority of patients to be successfully fed enterally.
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To consider the evidence for the beneficial effects of the current management guidelines in traumatic brain injury, and to highlight the important issues. ⋯ The impact of management guidelines in traumatic brain injury on patient outcome has been difficult to determine. However, there is a large body of uncontrolled evidence that suggests secondary global cerebral ischaemia-hypoxic insults are the major determinants in influencing outcome and that therapeutic interventions that maintain and defend cerebral perfusion pressures may improve outcome.
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To review the recent advances in ventilatory therapy for acute respiratory failure in children. ⋯ High frequency ventilation exists in three forms, although only high frequency oscillation appears to show any benefit in the management of acute respiratory failure refractory to conventional mechanical ventilation. Extracorporeal oxygenation has halved mortality in neonates with acute respiratory failure, and has been used successfully in non-neonate patients. Inhaled nitric oxide from 6 to 20 parts per million improves oxygenation in paediatric patients with acute respiratory failure and congenital heart disease (particularly in the presence of pulmonary arterial hypertension). Liquid ventilation or perfluorocarbon-associated gas exchange has also been used to treat acute respiratory failure in paediatric patients, with partial liquid ventilation particularly appearing to show promise.