Articles: critical-care.
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Annals of neurology · Oct 1996
Acute myopathy of intensive care: clinical, electromyographic, and pathological aspects.
An acute myopathy of intensive care occurs in critically ill patients treated with intravenous corticosteroids and neuromuscular junction-blocking agents. The full clinicopathological spectrum is uncertain. We evaluated the clinical, electrodiagnostic, and histopathological features of 14 patients who developed acute myopathy of intensive care after organ transplantation or during treatment of severe pulmonary disorders and sepsis. ⋯ Loss of thick filaments was identified in muscle biopsy specimens obtained 30 +/- 11 days (mean +/- standard deviation) after intravenous corticosteroid treatment but not in those obtained earlier (12 +/- 2 days). Critically ill patients, including those receiving organ transplants, may develop acute myopathy of intensive care after exposure to intravenous corticosteroids and neuromuscular junction-blocking agents, although the exposure to the latter drugs may be minimal. Selective loss of thick filaments is common in acute myopathy of intensive care, especially if the muscle biopsy specimen is obtained 2 weeks or more after intravenous corticosteroid exposure.
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Blood cultures are commonly obtained to delineate an infectious process in the ill surgical patient with fever, leukocytosis, or other septic parameters. We studied how often bacteremia was diagnosed, whether a positive blood culture changed therapy, and the cost analysis of this practice. ⋯ Routine ordering of blood cultures is not cost-effective, rarely alters or provides therapeutic direction, and appears not to affect mortality. Obtaining clinically indicated blood cultures as a secondary rather than a primary diagnostic measure is suggested.
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This study of the safety of patients undergoing mechanical ventilation was undertaken to ensure correct ventilation and to find quality-control elements for patients and nursing staff. Differences in mode programming and ventilation parameters and their registry at the change of nursing shifts, and correct programming of the sensitivity and minimum minute volume alarms and maximum airway pressure alarms were examined. In a two-month period, 8 cross-sectional studies were made of G1 prevalence in each of three nursing shifts. ⋯ Two hundred forty-eight G1 and 250 G2 recordings were made. The G2 studies revealed a generalized reduction in errors for all parameters. We concluded that the corrective measures were effective so these indicators were included in the monitoring of risk areas in the unit quality control program.
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Neuromuscular blocking agents (NMBAs) are used in many critically ill patients, although their use is declining. NMBAs are designed for short term use in the operating theatre, and there are few studies in the critical care setting of either efficacy or safety, in particular their metabolism may be impaired by organ dysfunction. Weakness associated with critical illness is multifactorial, but in many cases is associated with myopathies and neuropathies. The possible role of NMBAs in the development of weakness is unclear, but there is no proven link between the use of NMBAs and neuropathy or myopathy.