Articles: intensive-care-units.
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Comparative Study
End-tidal carbon dioxide measurements in critically ill neonates: a comparison of side-stream and mainstream capnometers.
To determine whether end-tidal PCO2 (PETCO2) measurements obtained with two infrared capnometers accurately approximates the arterial PCO2 (PaCO2) in critically ill neonates, simultaneous measurements of PETCO2 were obtained from the distal and proximal ends of the tracheal tube with a sidestream capnometer (Puritan Bennett/Datex--BP/D) and from the proximal end with a mainstream capnometer (Hewlett-Packard-HP) in 20 intubated neonates. Distal sidestream PETCO2 and mainstream PETCO2 correlated with the PaCO2 (r2 = 0.66 and 0.61, respectively) within the range of 26-57 mmHg PaCO2. However, proximal PETCO2 with the sidestream capnometer correlated very poorly (r2 = 0.09) with PaCO2. ⋯ The slope of the regression for the proximal sidestream capnometer did not differ significantly from horizontal. Insertion of the mainstream sensor for the HP capnometer significantly increased the transcutaneous CO2 when compared with preinsertion values. We conclude that both distal sidestream and mainstream capnometry provide accurate estimates of the PaCO2 in critically ill neonates.
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Effective pain management in trauma patients requires an understanding of both the physiologic responses to injury, and the potential modification of these responses produced by analgesic and anesthetic agents. Complex, multisystem injuries occur frequently and therapeutic intervention for the control of pain must be carefully incorporated within the overall management plan. Pain management strategies for specific injuries are discussed.
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Narcotics are explored in this section. Receptor theory is presented. ⋯ Pharmacokinetics of classic methods of narcotic delivery are discussed and compared to newer technologies of delivery. Finally, a strategy for decision making in pain control, tying together all the concepts previously discussed, is given.
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Critical care clinics · Apr 1990
ReviewThe role of sedation in the ICU patient with pain and agitation.
Aside from being hard for physicians and staff to cope with, ICU agitation syndromes result in deterioration of hemodynamics and must be handled effectively. The interaction between pain and delirium is examined, as well as hemodynamic and metabolic syndromes that cause agitation in the ICU setting. The various medications useful in the treatment of pain and delirium are reviewed and new regimens discussed. Comprehensive treatment plans are reviewed for the profoundly agitated patient.
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To manage pain in an ICU setting effectively, one must first understand the unique features associated with the disease process for which patients are admitted. Although there are certain common denominators, a postoperative patient is different from a patient with an acute myocardial infarction. This article reviews the aspects of pain associated with the individual syndromes of patients admitted to an ICU.