Articles: intensive-care-units.
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Burn injuries produce severe wound care pain that is ideally controlled on intensive burn care units with high-dosage intravenous opioid medications. We report a case illustrating the use of hypnosis for pain management when one opioid medication was ineffective. ⋯ This case illustrates that hypnosis can not only be used easily and quite appropriately in a busy medical intensive care unit environment, but that sometimes this treatment may be a very useful alternative when opioid pain medication proves to be dangerous and ineffective. This case also illustrates possible clinical implications both pain relief and side-effect profiles for opioid receptor specificity. Although this report does not provide data regarding hypnotic mechanisms, it is clear that with some patients nonopioid inhibitory mechanisms can be activated in a highly effective manner, that clinical context may be important for the activation of those pathways, and that those mechanisms may be accessed more easily than opioid mechanisms.
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Although significant complications can result after upper airway surgery for obstructive sleep apnea (OSA), there is a lack of consensus regarding the most appropriate level of monitoring in the perioperative period. A retrospective analysis was performed on the operative records of 109 adult patients who underwent 125 surgical procedures from January 1, 1991, to May 31, 1996, with particular emphasis on complications that would have mandated intensive care monitoring and management. Airway complications occurred in one patient (0.8%), who became obstructed immediately after surgery; he responded to naloxone and suctioning. ⋯ Routine postoperative intensive care monitoring for all adult patients undergoing upper airway surgery for OSA is unnecessary. Although high-risk patients cannot always be identified preoperatively, significant complications generally emerge within 2 hours after surgery. Therefore a decision regarding the level of postoperative monitoring needed may be made with confidence during the period of time that the patient is in the recovery room.
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J Perinat Neonatal Nurs · Jun 1998
The clinical experience of continuous quality improvement in the neonatal intensive care unit.
Central line catheters are commonly placed in extremely low-birthweight infants to provide venous access for administration of hyperalimentation and medications. Infections is the most common complication of central line catheters in this patient population. ⋯ The continuous quality improvement process was used to modify central line practices, which led to a decrease in the rate of central line infections. For the first 8 months of 1997, the infection rate was below the 25th percentile according to the National Nosocomial infections Surveillance System data.
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Intensive care medicine · Jun 1998
Estimation of direct cost and resource allocation in intensive care: correlation with Omega system.
An instrument able to estimate the direct costs of stays in Intensive Care Units (ICUs) simply would be very useful for resource allocation inside a hospital, through a global budget system. The aim of this study was to propose such a tool. ⋯ The Omega system appears to be a simple and relevant indicator with which to estimate the direct costs of each stay, and then to organise nursing requirements and resource allocation.
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In summary, current data indicate that body temperature cannot be controlled efficiently by changing inspired gas temperature. Inspired gas temperature should therefore be maintained at 32 degrees C to 34 degrees C for intubated patients and other efforts should be made to optimize body temperature.