Articles: critical-care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 1998
Randomized Controlled Trial Clinical Trial[Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks].
Due to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport. ⋯ The combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.
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Off J Can Assoc Crit Care Nurs · Jan 1998
An assessment of a sedative algorithm for sleep in an intensive care unit.
The difficulty for intensive care unit (ICU) patients to obtain frequent and extensive sleep has been well-documented. This project assessed the benefit of an algorithm of pharmacological assistance (lorazepam and methotrimeprazine) on sedation level and sleep duration in the ICU. The setting was a 15-bed closed ICU dealing with medical and surgical patients in a tertiary care, teaching hospital. ⋯ Efforts to change nursing practice will be required to improve the quality and quantity of sleep in ICU patients. This clinical evaluation demonstrates that the implementation of an algorithm for medication use is not effective alone in obtaining the desired level and duration of sleep in ICU patients. Nursing practice should continue to look at non-pharmacological factors, such as environmental noise, patient interruptions, and patient care practice to determine strategies in addition to medications which would aid the critically ill patient in achieving adequate sleep.
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Critically ill patients exhibit a range of organ dysfunctions and often require treatment with a variety of drugs including sedatives, analgesics, neuromuscular blockers, antimicrobials, inotropes and gastric acid suppressants. Understanding how organ dysfunction can alter the pharmacokinetics of drugs is a vital aspect of therapy in this patient group. Many drugs will need to be given intravenously because of gastrointestinal failure. ⋯ Failure of the central nervous system, muscle, the endothelial system and endocrine system may also affect the pharmacokinetics of specific drugs. Time-dependency of alterations in pharmacokinetic parameters is well documented for some drugs. Understanding the underlying pathophysiology in the critically ill and applying pharmacokinetic principles in selection of drug and dose regimen is, therefore, crucial to optimising the pharmacodynamic response and outcome.