Articles: intensive-care-units.
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Critically ill patients admitted to an intensive care unit (ICU) are rapidly evaluated, and aggressive management is immediately instituted. They are intubated and placed on mechanical ventilation, and invasive monitoring is begun. Many patients are successfully treated and discharged from the ICU, but unfortunately a large percentage of the critically ill do not improve and become chronically critically ill. ⋯ We present a management strategy for improving the prognosis of the chronically critically ill patient by concentrating on exercise, nutrition, fluid management, emotional support, and adequate sleep. We address issues dealing with withholding and withdrawing extraordinary life support. We conclude by demonstrating how these concepts were applied in the case of a chronically critically ill young man with the acquired immunodeficiency syndrome (AIDS).
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Br Med J (Clin Res Ed) · Apr 1985
Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care.
Sleep was studied in nine patients for two to four days after major non-cardiac surgery by continuous polygraphic recording of electroencephalogram, electrooculogram, and electromyogram. Presumed optimal conditions for sleep were provided by a concerted effort by staff to offer constant pain relief and reduce environmental disturbance to a minimum. All patients were severely deprived of sleep compared with normal. ⋯ The sustained wakefulness could be attributed to pain and environmental disturbance to only minor degree. Sleep time as estimated by nursing staff was often grossly misjudged and consistently overestimated when compared with the parallel polygraphic recording. The grossly abnormal sleep pattern observed in these patients may suggest some fundamental disarrangement of the sleep-wake regulating mechanism.
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Critical care medicine · Apr 1985
Predictability and consequences of spontaneous extubation in a pediatric ICU.
To determine the incidence of, and the factors contributing to spontaneous extubation (SE), we followed prospectively all intubated children admitted to a pediatric ICU. Eleven potential risk factors were monitored and scored twice daily for 8 consecutive months. Using data from the first 204 patient admissions, we evaluated the risk factors by orthogonal discriminant analysis and found that four factors (patient age, amount of secretions, endotracheal tube slippage, and state of consciousness), when considered together, had good discriminating power for SE vs. intentional extubation. ⋯ The effect of extubation on gas exchange was the same for spontaneously and intentionally extubated patients. No morbidity or deaths were attributed to SE. Standard ventilator low-pressure alarms did not reliably signal the presence of SE, nor did upper extremity restraints keep patients from extubating themselves.
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Up to now there are almost no investigations on the situation of relatives of ICU patients. Therefore a study was designed into the impressions left on relatives by intensive care treatment in their next of kin. A questionnaire including 46 items was developed which mainly refers to the following topics: first contact with the ICU, experience with the situation in the ICU, information given on the patient's state, psychosocial assistance, evaluation of experiences made in the ICU. ⋯ The relation to the medical and nursing staff is described as positive, especially by relatives of surviving patients. In retrospect the relatives--like the former ICU patients--hold a positive view of the intensive care unit. The reasons are discussed.