Articles: outcome.
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To review the technology and the role of continuous intra-arterial blood gas monitoring in critical illness. ⋯ Over the last 10 years, a number of continuous intra-arterial blood gas monitoring systems have been developed. Only a few have reached commercial availability. While the performance characteristics of these systems are comparable, the levels of accuracy of these systems obtained in vitro are not consistently obtained in clinical trials. Arterial blood flow, wrist movement, wall effect and variability of blood gas analysers are some of the factors which determine the accuracy and reproducibility of these systems. Evidence to support the clinical usefulness of these monitors exists only in the form of case studies. Controlled studies demonstrating an improvement in outcome with the use of these monitors are lacking.
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To discuss the clinical indications and complications of non-invasive ventilation. ⋯ Non-invasive ventilation using the modes of CPAP, PSV, BiPAP and NIPPV should be considered in patients with respiratory disorders who remain in acute respiratory failure despite conventional therapy, before considering invasive mechanical ventilation.
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To discuss the reasons why 250 ml 7.5% hypertonic saline was chosen as a pre-hospital resuscitation fluid for head injured patients in a multicentred, prospective, randomised controlled trial investigating its long term effects on central nervous system outcome. ⋯ Pre-hospital resuscitation of head injured and hypotensive trauma patients using hypertonic saline, has the potential to reduce long term cerebral injury and reduce social and financial costs to the community.
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To determine whether the addition of intravenous dexamethasone to standard emergency department (ED) migraine therapy would decrease the incidence of severe recurrent headache 24 to 48 hours after initial treatment. ⋯ Migraine recurrence is common after "successful" ED treatment. Inflammation may be a critical factor in migraine genesis. Intravenous dexamethasone decreases the incidence of severe recurrent headache after ED treatment and should be offered to patients thought to be at risk of recurrent headache.
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Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the "gold standard," and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes. ⋯ In addition, all patients (those with cancer or nonmalignant pain) must exhibit a positive response to an epidural or intrathecal screening test. A multidisciplinary team approach, involving psychologists, nurses, physical therapists, social workers, and spiritual leaders should be used to manage patients. Current practices for patient selection and management, screening tests, and dosing guidelines for intrathecal drug delivery systems are discussed.