Articles: intensive-care-units.
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It has been estimated that between 12.5% and 38% of conscious patients admitted to critical care settings experience Intensive Care Unit psychosis, a condition which seems to resolve upon transfer to the ward. This phenomenon was traditionally recognized when the patient outwardly exhibited abnormal behaviours and signs in the form of confusion, delirium, anxiety, depression, delusions and audiovisual hallucinations, yet it has been argued that due to the illness of the patient and their suppressed ability to communicate, such overt displays of unusual behaviour are the tip of the iceberg. In recognizing this phenomenon, it is felt that a relationship exists between Intensive Care Unit Psychosis, the therapeutic nurse-patient relationship, and the environment in which nurses' interactions with their clients occur. This paper will explore the interaction between these three elements while considering the implications for contemporary nursing practice.
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Intensive care medicine · May 1999
Clinical Trial Controlled Clinical TrialEvaluation of a new, rapid lactate analyzer in critical care.
To determine the reliability, precision and clinical usefulness of a newly developed substrate-specific lactate/blood gas analyzer (Chiron M865). ⋯ The new Chiron lactate analyzer is reliable for serial whole blood lactate measurements in an intensive care stat laboratory. Samples should be kept on ice immediately after sampling to minimize in vitro erythrocyte production of lactate.
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Critical care medicine · May 1999
Comparative StudyPrognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis.
To compare prognostic scoring systems in a retrospective series of patients with severe acute pancreatitis admitted to a surgical intensive care unit (ICU). ⋯ Once a patient is admitted to the surgical ICU, several predictors of mortality or complications that will require long hospitalization times are evident. In this sample of patients, APACHE III scores >30 at 96 hrs, 5 or more Ranson criteria, and a modified Imrie (Glasgow) score of >3 predicted those who died or had multiple complications. Those patients with combined 48-hr and 96-hr APACHE III scores of >60 either died or had hospitalizations of >60 days. These patients had major pancreatic complications that included pancreatic necrosis, pancreatic abscess, pseudocyst, hemorrhagic pancreatitis, and pancreatic ascites.
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To describe patients' and family members' perceptions of transfer from an intensive care unit (ICU). ⋯ Patients and family members perceived the transfer from the ICU as a significant and sometimes negative event.
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Critical care medicine · May 1999
Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System.
To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States. ⋯ The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.