Articles: intensive-care-units.
-
Nihon Kyobu Shikkan Gakkai Zasshi · Dec 1995
[Mechanical ventilation and long-term respiratory care in the intensive care unit of a general hospital].
We studied the need for mechanical ventilation in 265 patients with respiratory failure who came to our medical ICU over the past 3 years. The time required for weaning from mechanical ventilation and the percentage of patients who needed oxygen therapy or mechanical ventilation at home after their condition was no longer acute were also studied. Of the patients treated in the medical ICU, 143 (54%) required mechanical ventilation; 104 (39%) had acute respiratory failure and the others had acute exacerbations of chronic respiratory failure. ⋯ Ten other survivors received home oxygen therapy. Chest physicians bear the greatest responsibility for managing mechanical ventilation in medical emergencies. Moreover, the prognosis for patients with chronic respiratory failure can be improved with a long-term program for respiratory care that includes home mechanical ventilation and home oxygen therapy.
-
The thresholds of the diagnostic procedures performed to diagnose ICU-acquired pneumonia (IAP) are either speculated or incompletely tested. ⋯ Using the classic thresholds, sensitivity was 67% for PSB, 54% for PTC, 59% for BAL D, and 77% for BAL C. Specificity was 88% for PSB, 77% for PTC, 98% for BAL D, and 77% for BAL C. We used receiver operating characteristics methods to reappraise thresholds. Decreasing the thresholds to 500 cfu/mL for PSB, 10(2) cfu/mL for PTC, 2% cells containing bacteria for BAL D, 4 x 10(3) cfu/mL for BAL C increased the sensitivities (plus 14%, 23%, 25%, 10%, respectively) and moderately decreased the specificities (minus 4%, 9%, 2%, 4%, respectively) of the four examinations. The association of PSB with a 500 cfu/mL threshold and BAL D with a 2% threshold recovered all but one episode of pneumonia (SE 96 +/- 4%) with a 84 +/- 10% specificity. For a similar ICU population, these "best" thresholds increased negative predictive value with a minimal decrease of positive predictive value. They need to be confirmed in multiple ICU settings in prospective fashion.
-
Sedation in the critically ill patient is essential to ensure maximal quality of life in the high-stress environment of the intensive care unit. The main goals of sedation include augmentation of pain control, management of agitation and psychological distress, and improvement of patient tolerance and acceptance of the endotracheal tube and ventilatory support. ⋯ Other agents which have been employed include, other opiates such as fentanyl and sufentanil, butyrophenones such as haloperidol, and anesthetics such as propofol. These agents will be reviewed with respect to their role in sedating the critically ill patient.