Articles: critical-care.
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Intensive care medicine · Apr 1997
Randomized Controlled Trial Clinical TrialUnfavorable mechanical effects of heat and moisture exchangers in ventilated patients.
To investigate the mechanical effects of artificial noses. ⋯ The artificial noses cause unfavorable mechanical effects by increasing inspiratory resistance, ventilation requirements, and dynamic intrinsic PEEP. Clinicians should consider these effects when setting mechanical ventilation and when assessing patients' ability to breathe spontaneously.
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To identify areas requiring the most urgent improvement in the intensive care unit (ICU); and to accurately determine the positive predictive value of routine critical care patient monitoring alarms, as well as the common causes for false-positive alarms. ⋯ Efforts to develop intelligent monitoring systems have more potential to deliver significantly improved patient care by initially targeting especially weak areas in ICU monitoring, such as pulse oximetry reliability.
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India is a vast democracy of nearly one billion people. Before the British rule ended in 1947, the life span of an Indian was a mere 21 years. Within a short span of 50 years, it increased to an impressive 63 years, largely due to public health measures initiated by the government. ⋯ Critical care medicine, as practiced in the West, is still confined to large Metropolitan areas. A large pool of expatriate Indian physicians from all over the world are helping bridge the resource gap between the West and India by transfer of technology and providing appropriate training to physicians and paramedical personnel. This article describes the history and current status of development of critical care medicine in India.
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Intensive Crit Care Nurs · Apr 1997
Exploring dichotomies of caring, gender and technology in intensive care nursing: a qualitative approach.
Intensive care nursing involves combining caring, seen as a feminine trait, with the ability to work with technology, often viewed as masculine. This study explored nurses perceptions of their work, particularly in relation to whether there are differences between the sexes in caring ability and the planned career paths of female and male nurses. ⋯ The results challenge previous studies which state that male nurses are attracted to these areas because of the technology and that they wish to climb the career ladder more quickly than their female colleagues. Nurses in intensive care units generally chose such work because they were able to provide, in their own opinions, a high standard of nursing care to patients and were able to maintain direct patient contact if they wished to achieve sister/charge nurse posts.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Review[Mild and moderate hypothermia as a new therapy concept in treatment of cerebral ischemia and craniocerebral trauma. Pathophysiologic principles].
Hypothermia protects the brain and other vital organs during periods of ischaemia. We differentiate between mild (36-34 degrees C), moderate (33-29 degrees C), deep (28-17 degrees C) and profund (16-4 degrees C) hypothermia. During hypothermia, cerebral metabolic rate and cerebral blood flow decrease dependent on temperature. ⋯ In most instances, deep hypothermia renders neurologic outcome worse, which is most likely related to the generation of toxic metabolites and inadequate myocardial function during rewarming. The neuroprotective effects of hypothermia are related to several mechanisms along the ischaemic cascade: prevention of postischaemic hypoperfusion, reduction of functional and basal metabolism, decreased accumulation of lactic acid and oedema formation, inhibition of excitatory neurotransmitter release, prevention of Ca(++)- and Na(+)-influx, inhibition of lipid peroxidase activity, and free radical formation, stimulation of regenerative immediate early genes. The side effects of hypothermia include myocardial ischaemia, cardiac arrhythmias, decreased left ventricular contractility, coagulation abnormalities, and suppression of metabolic and immunological processes.