Articles: critical-care.
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Ann Acad Med Singap · May 1998
ReviewContributions of respiratory care practitioners to intensive care: a review.
Through the years, the professional practice of respiratory care has continually evolved to include management of critically ill patients. Although the functions and duties of respiratory care practitioners (RCPs) in this setting may vary across different institutions, it is widely recognised throughout the United States that RCPs contribute importantly to intensive care unit (ICU) outcomes. ⋯ Other ICU activities in which RCPs participate include assisting with bronchoscopy, obtaining haemodynamic measurement, and indirect calorimetry and supporting specialised techniques such as extracorporeal membrane oxygenation (ECMO) and continuous veno-venous haemofiltration and/or haemodiafiltration (CVVH/CVVHD). Based on the demonstrated impact of RCPs and their technical and cognitive training, a continuing role expansion for RCPs in the ICU is expected.
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American heart journal · May 1998
Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants.
Therapeutic decision making in critically ill patients requires both prompt and comprehensive analysis of available information. Data derived from randomized clinical trials provide a powerful tool for risk assessment in the setting of acute myocardial infarction (MI); however, timely and appropriate use of existing therapies and resources are the key determinants of outcome among high-risk patients. ⋯ This large registry experience included more than 150,000 nonselected patients with MI and suggests that high-risk patients can be identified on initial hospital presentation. The current use of reperfusion and adjunctive therapies among high-risk patients is suboptimal and may directly influence outcome. Randomized trials designed to test the impact of specific management strategies on outcome according to initial risk classification are warranted.
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Electrolyte abnormalities, hypertension and acute renal failure commonly occur in children admitted to the intensive care unit. Perturbations in sodium, potassium, and calcium or hypertensive crisis require prompt therapy to avoid major cardiac or neurological events. Hemodialysis, peritoneal dialysis, or hemofiltration can effectively and safely be performed, even in small and hemodynamically unstable children. Although suitable equipment is available for all renal replacement options, attention to precise details such as fluid administration and flow rates are essential.
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Critical care medicine · May 1998
Review Comparative StudyComplications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens.
To describe the various complications that have been reported with use of midazolam for sedation in the intensive care unit (ICU). ⋯ Continuous infusion midazolam provides effective sedation in the ICU with few complications overall, especially when the dose is titrated.
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Despite the wide number of diseases currently or previously treated with plasma exchange and plasmapheresis, the clinical effectiveness of these treatments has been established by large, controlled clinical trials only in few clinical conditions. The firmly accepted and the possible indications for these techniques in critically ill patients are reviewed and discussed, as well as their complications and possible side effects.