Articles: intensive-care-units.
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Intensive care medicine · Dec 1996
Intensive care management of paediatric organ donors and its effect on post-transplant organ function.
1. To document the clinical course of paediatric beating heart organ donors. 2. To evaluate the effect of the ICU management of pediatric donors on the immediate function of transplanted organs. 3. To examine the validity of current donor selection criteria. ⋯ Aggressive fluid resuscitation and management of diabetes insipidus may promote stability in paediatric organ donors. Donor cardiac arrest does not alter the ICU course or compromise post-transplant organ function. The current criteria used for donor selection failed to predict post-transplant organ function and their use may increase organ wastage.
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Respir Care Clin N Am · Dec 1996
ReviewMetabolic measurements during mechanical ventilation in the pediatric intensive care unit.
The metabolism of critically ill infants and children is significantly influenced by their underlying diseases, and standard predictive equations result in inappropriate nutritional support in most of these patients. Furthermore, significant day-to-day variability in energy expenditure may be present in individual patients. ⋯ With the wide availability of proprietary metabolic carts suitable for use in mechanically ventilated pediatric patients, serial metabolic measurements via indirect calorimetry are feasible in most critically ill infants and children. The use of indirect calorimetry should also be considered in this population to assess changes in oxygen consumption and the relationship of oxygen consumption to oxygen delivery in response to changes in therapy, such as manipulation of cardiac output using vasoactive medications, or during weaning of mechanical ventilation.
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A one year prospective, observational survey was performed to evaluate the abnormal carriage of multi-resistant Klebsiella pneumoniae and/ or Acinetobacter baumannii, to determine associated risk factors for carriage, and to correlate the abnormal carriage with infectious morbidity and mortality in the intensive care unit (ICU) of a University Hospital. Two hundred and ninety-eight patients who stayed in the ICU > 48h, and were not neutropenic, were studied. Salivary and rectal samples were obtained on admission and weekly until discharge. ⋯ Mortality was significantly greater in the carrier group (43 vs 25%, P = 0.0006). Post hoc stratification suggested that abnormal carriage only influenced mortality in patients showing a low severity of illness score on admission to ICU. Abnormal carriage was found in the most severely ill patients, predisposed to secondary nosocomial infections, and could influence mortality in the less severely ill.
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Respir Care Clin N Am · Dec 1996
ReviewSedation, analgesia, and neuromuscular blockade during pediatric mechanical ventilation.
The mechanically ventilated PICU patient is subjected to multiple noxious stimuli ranging from a bright, noisy, and intimidating environment to painful but necessary procedures. His or her primary disease process or processes obviously constitutes another potential source of noxious stimuli as well. As a result, these patients almost certainly need some combination of medications to allay anxiety, treat discomfort, and perhaps otherwise optimize medical management. ⋯ Although the frequent need for analgesics, sedatives, and NMBDs in the PICU is undisputed, the development of reliable methods for accurately assessing the degree of patient sedation or analgesia will greatly facilitate efforts to improve patient care Appropriate use of sedatives, analgesics, and NMBDs provides an invaluable service. It is important to remember, however, that even in the high-technology PICU environment verbal and physical reassurance remains a powerful tool for providing comfort and anxiolysis to critically ill children. There is no pharmacologic equivalent of human compassion.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Nosocomial infections intensive care units. A nation-wide prevalence study].
In a large, multicenter survey in 1994, the prevalence of nosocomial infections in German hospitals was examined, predominant pathogens were identified, and possible risk factors evaluated. In this paper the results from the intensive care units (ICUs) are presented. ⋯ Nosocomial infections are seen far more often in ICUs than on normal wards due to the immuno-suppressed state of many ICU patients and the continuous use of invasive diagnostic and therapeutic procedures. Most of these infections are of endogenous origin. Other prevalence surveys have shown results comparable to ours. Daily changing of ventilation tubes is no longer necessary, but is still routine in many hospitals. Infusion sets were also changed more often than required. The use of selective decontamination of the digestive tract for the prevention of pneumonia is still controversial; in our study it was practised in only 1.5% of the cases. The most commonly used drugs for the prevention of stress ulcers were H2-receptor blocking agents, although it has been shown that sucralfate is the better choice, as it can help prevent nosocomial pneumonia. Routine microbiological surveillance of tracheal aspirates and urine was done in 25.9% and 24.6% of the ICUs. No study so far has shown that routine cultures of tracheal secretions and urine have a preventive effect regarding infection.