Articles: critical-care.
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Intensive Crit Care Nurs · Oct 1996
Patient's experiences of communication during the respirator treatment period.
This paper reports a study of the patients' experiences of communication during the respirator treatment period (RT period) in the intensive care unit (ICU). This descriptive and exploratory study was designed to answer the question. How do respirator treated patients experience communication? Eight individuals who had experienced being treated with a respirator in two ICUs in Iceland, took part in audiotape-recorded, open interviews. ⋯ The presence and support provided by family members was also valuable to them. The results add to the cumulative knowledge base of communication between nurses and patients by generating new meanings of the nature and essences of communication during the RT period from the patients' perspectives. In this article, the findings of the study are described and discussed in relation to earlier published research and clinical literature on the subject.
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The American surgeon · Oct 1996
When is ICU care warranted after carotid endarterectomy? A three-year retrospective analysis.
The purpose was to determine the valid indications for Surgical Intensive Care Unit (SICU) admission after carotid endarterectomy (CEA). The indications for admission to the SICU after CEA were studied over a 3-year period (4/89-3/92). Absolute indications for ICU admission (AIA) included mechanical ventilation, a pulmonary artery catheter, and intravenous vasoactive or antiarrhythmic drug infusion. ⋯ Two patients in Group A died; no patients died in Group B or C. Only patients with an AIA, perioperative neurological changes, or early hemodynamic instability require SICU admission after CEA. An observation period in the recovery room allows for selection of nearly all patients who will eventually require SICU care.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Influence of different volume therapy regimens on regulators of the circulation in the critically ill.
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low-molecular weight HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5 days, otherwise patient management did not differ between the two groups (trauma/sepsis). ⋯ In both sepsis groups, vasopressors (vasopressin, endothelin-1, noradrenaline and adrenaline) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients. Concentrations of atrial natriuretic peptide increased only in the HA patients (from 159 (SD 31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased significantly only in the HES sepsis patients (from 112 (25) to 47 (15) pg ml-1).
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Critical care clinics · Oct 1996
ReviewPulmonary artery catheters in the critically ill. An overview using the methodology of evidence-based medicine.
Evidence-based approaches to assessing the clinical literature are used increasingly in issues relating to critical care medicine. As we discussed previously, this approach attempts to provide a logical and convenient framework from which the quality and relevance of clinical studies may be assessed in an unbiased manner. An evidence-based approach also allows the reader to differentiate between solid evidence and evidence that is based on a presumed mechanism, standard practice, or conventional wisdom. ⋯ However, what this exercise has taught us is that there is little objective evidence to support this conclusion. The challenge to critical care practitioners is not only to apply the evidence-based processes more frequently to our environment but also to use the information to separate out clearly what is fact versus opinion. Where there is little evidence to support a particular clinical practice, as we have demonstrated with the PAC review earlier, the challenge to the clinician should be the design and conduct of clinical trials clarifying debate between opinion and evidence.