Articles: critical-care.
-
Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. ⋯ Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.
-
Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSafety and efficacy of increasing dosages of glycyl-glutamine for total parenteral nutrition in polytrauma patients.
Supplementation of parenteral nutrition with glutamine (GLN) has been suggested to improve the efficacy of nutritional support by stimulating protein synthesis and improving immunocompetence. In the present study we investigated the impact of infusing the dipeptide glycyl-glutamine (GLY-GLN) at increasing dosages on plasma amino acid concentrations in patients with polytrauma. Nine polytraumatized patients were randomly assigned according their age and their trauma score to three experimental groups. ⋯ We conclude from this first available dose finding study on glutamine-containing dipeptides that in polytraumatized patients infusion of 570 mg/kg/day of GLY-GLN (corresponding to 28 g glutamine or 40 g dipeptide/70 kg, respectively) is necessary to induce a sustained effect on plasma glutamine concentrations. No pathological accumulation of free glycine or of the dipeptide was seen with any of the three dosage steps of GLY-GLN. Thus, the administration of even high doses of GLY-GLN is feasible and safe in patients with polytrauma and is not associated with any relevant renal substrate loss.
-
Critical care clinics · Jan 1996
ReviewNeonatal and pediatric critical care: ethical decision making.
The current standards for surrogate decision making for children are analyzed in this article. A number of potential pitfalls are involved with this issue, including questions about the child's maturity and competence. The present approach for medical decision making for noncompetent children is the "best interest" standard. In many medical decisions, the "best interest" standard is not applicable and a "rational parent" standard is presented.
-
Over the last 30 years intensive care medicine has undergone drastic changes not only because of changes in patient population but also because of the progress in medical technology. Given that resources are finite and limited medical and socio-ethical principles should be applied for the distribution and withdrawal of these resources. ⋯ Whilst in intensive care patients should be scored every day to identify as early as possible those patients who are going to die and those who are going to survive in order to use intensive care resources efficiently. After discharge from intensive care quality of life should be an important factor to assess intensive care performance.
-
Scand J Clin Lab Invest Suppl · Jan 1996
ReviewElevations in blood lactate: overview of use in critical care.
Blood lactate measurements are being used clinically as an indicator of circulatory impairment and the overall state of oxygenation of patients in critical care. This report briefly covers the areas of usage of lactate testing, lactate biochemistry, appropriate sample handling, and clinical interpretation of lactate measurements in critical care monitoring including pediatric cardiac surgery and extracorporeal membrane oxygenation (ECMO).