Articles: critical-care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1997
Randomized Controlled Trial Clinical Trial[Effect of hydroxyethyl starch solution on kidney function in surgical intensive care patients].
Hydroxyethyl starch is commonly used in resuscitation, anaesthesia and intensive care medicine. Increasing creatinine values in patients treated with hydroxyethyl starch have been described in some case reports. These have also been some clinical signs such as pain in the renal region, and swelling of kidney parenchyma, but no differential and sensitive parameters of renal function have supported these possible side effects of hydroxyethyl starch. ⋯ Correlates of tubular damage after hydroxyethyl starch therapy were seen in intensive care patients. Many influences of intensive therapy act on renal function, and further studies with larger cohorts are necessary. With regard to the documented localisation of the tubular damage in the HES group, colloid therapy with hydroxyethyl starch in renal dysfunction should be monitored carefully by means of sensitive markers.
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Critical care services are an identified, resource-intensive component of health-care provision. Examining cost containment and clinical effectiveness in this specialty is therefore highly appropriate, although difficult to achieve in practice. The studies reviewed in this paper utilised various methodologies to capture different components of service and patient costs. ⋯ Differing methods and data collection resulted in a limited comparative analysis, but issues requiring further research are highlighted. Funding of ICU services in Australia and nursing staff costs are also discussed. Future research will be aided by further sophistication in clinical information systems and the desire for clinicians to examine the link between costs and outcomes of the different activities pursued within the ICU.
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Comparative Study
Post-ICU mechanical ventilation: treatment of 1,123 patients at a regional weaning center.
To update our database, reporting changes in the results of weaning attempts and profile of patients transferred to us after prolonged mechanical ventilation (PMV) in the ICU. ⋯ Patients are being transferred from the ICU to our RWC for attempted weaning sooner in their course of PMV. Although more severely ill on arrival than in past years, mortality is unchanged, more than half of the patients continue to be successfully weaned, and survival after RWC discharge is improved.
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A 10-bed state-of-the-art burns unit was commissioned at King Fahd Specialist Hospital, Buraidah, Al-Qassim and the first 90 cases admitted to the unit over an 18-month period were analysed. The mean age (+/-SD) was 14.9 (+/-1.5) years with a range of 6 months-55 years. Fifty-one per cent were males, 52.2 per cent were children under 12 years of age and of these 85.1 per cent were under 5 years of age. ⋯ Factors that can improve the morbidity and mortality rates in patients are highlighted. The study also reveals certain patterns and etiological factors in the Qassim region. Prevention by education through a national campaign remains the keystone in reducing the incidence of burns particularly in children and the maximization of resources.
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Crit Care Nurs Clin North Am · Jun 1997
ReviewWomen who return to abusive relationships: a frustration for the critical care nurse.
Nurses caring for abused women become frustrated and concerned when their patients return to the violent relationship. This disconcerted feeling can hinder the care nurses render to these women, subsequently leaving the victim powerless. Understanding this phenomenon can improve patient care, increase the image of women and, ultimately, help banish violence against women.