Articles: intensive-care-units.
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
Randomized Controlled Trial Comparative Study Clinical TrialInfusion of propofol versus midazolam for sedation in the intensive care unit following coronary artery surgery.
The use and the hemodynamic effects of propofol and midazolam were studied during titrated continuous infusions to deep sedation (sedation level 5: asleep, sluggish response to light glabellar tap or loud auditory stimulus) following coronary artery surgery. The drugs were compared in 30 ventilated patients in an open randomized study. The duration of infusion was approximately 570 minutes in both groups. ⋯ The time from stopping sedation to patient responsiveness was 11 +/- 8 minutes in the propofol group and 72 +/- 70 minutes in the midazolam group (P < 0.001), and the time from stopping sedation to extubation was 250 +/- 135 minutes and 391 +/- 128 minutes (P < 0.014), respectively. Following the loading dose of propofol, there was a fall in blood pressure (BP) (mean from 80 +/- 11 mmHg to 67.5 +/- 10 mmHg; P < 0.05). After approximately 15 minutes, BP started to rise but remained below pretreatment level throughout sedation.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Apr 1993
The effect of a cardiac surgical recovery area on the timing of extubation.
The anesthetic and postoperative management of cardiac surgical patients was modified to achieve an early return to spontaneous ventilation. A total of 278 patients were studied to determine the effect of this change. Patients in group I (n = 198) were managed in a cardiac surgical recovery area according to the new policy. ⋯ The median duration of postoperative ventilation was reduced from 5 hours in group II to 1 hour in group I, and the time to extubation was reduced from 7 hours to 2 hours, respectively. There were no major postoperative complications resulting from this change. The factors that influence the duration of postoperative ventilation are discussed.
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Critical care medicine · Apr 1993
ReviewCivilian triage in the intensive care unit: the ritual of the last bed.
To evaluate the numerous problems that exist when there is an acute shortage of trained critical care nurses, no triage officer is available or designated, there is no cooperation among intensive care units (ICUs) or alternative sites, or there is excessive political or financial pressure applied to maintain a referral practice or to fill all the beds, or limited ability to divert ambulances to other hospitals. The Joint Commission on Accreditation of Health Care organizations now mandates a written policy: "when patient load exceeds optimal operational capacity" (1992). ⋯ It is necessary to have public disclosure of the broader issues related to high-level triage. The first issue is recognition that there are periods of time when ICU capacity is exceeded or skilled critical care nurse availability is reduced. The next issue is the decision of who is best suited to make complex and dynamic triage decisions and what kind of oversight should be provided. Other issues relate to whether there should be patient or family consent, and what to do about patients receiving marginal benefit or who are considered hopeless or unsalvageable, yet the family or surrogate decision maker (or perhaps one of the consultants) wants to continue active care in the ICU. In the conflict between individual and community rights and benefits, there should be a nonlitigious approach when a patient is harmed during these periods of high census or limited capacity. In recognition of these complex issues (including potential conflicts among ICUs, hospital administration, individual physicians, and the various medical and surgical programs feeding patients into special care units), the Society of Critical Care Medicine has organized a Task Force on the legal and ethical justification for triage.
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Critical care medicine · Apr 1993
Endocrine profiles for outcome prediction from the intensive care unit.
To evaluate the discriminating ability of various specific endocrine studies on patient outcome from the intensive care unit (ICU). ⋯ The basal cortisol and triiodothyronine concentrations obtained from blood samples collected within 48 hrs of ICU admission appear to be better discriminators of patient outcome than the APACHE II score.
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To describe the structure and organization of pediatric intensive care units (ICUs) in the United States. ⋯ Substantial diversity exists in pediatric ICU structure and organization. Determining factors associated with quality of care is important for improving outcomes.