Articles: critical-care.
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Rev Esp Anestesiol Reanim · Oct 1995
[Prolonged sedation with midazolam in critically ill patients undergoing artificial ventilation].
To analyze the dose of midazolam needed for induction and maintenance of sedation, as well as its hemodynamic repercussions in critically ill patients requiring mechanical ventilation. ⋯ The sedation dose of midazolam in critically ill patients is related to weight and plasma albumin levels. Recovery time is related to mean maintenance dose.
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Critical care medicine · Oct 1995
ReviewA model for technology assessment as applied to closed loop infusion systems. Technology Assessment Task Force of the Society of Critical Care Medicine.
To test a model for the assessment of critical care technology on closed loop infusion control, a technology that is in its early stages of development and testing on human subjects. ⋯ Closed loop infusion systems may have a role in critical care practice. However, for most applications, further development is required to move this technology from the innovation phase to the point where it can be evaluated so that its role in critical car practice can be defined. Each application of closed loop infusion systems must be independently validated by appropriately designed research studies. Users should be provided with the clinical parameters driving each closed loop system so that they can ensure that it agrees with their opinion of acceptable medical practice. Clinical researchers and leaders in industry should collaborate to perform the scientifically valid, outcome-based research that is necessary to evaluate the effect of this new technology. The original model we developed for technology assessment required the addition of several more questions to produce a complete analysis of an emerging technology. An emerging technology should be systematically assessed (using a model such as the model developed by the Society of Critical Care Medicine), before its introduction into clinical practice in order to provide a focus for human outcome validation trials and to minimize the possibility of widespread use of an unproven technology.
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Critical care medicine · Oct 1995
ReviewStandards of evidence for the safety and effectiveness of critical care monitoring devices and related interventions. Coalition for Critical Care Excellence: Consensus Conference on Physiologic Monitoring Devices.
To devise alternatives to randomized, controlled, clinical trials that clinicians and research experts might find acceptable for approval of devices used in critical care medicine. ⋯ The panel agreed on the following major recommendations: a) the FDA should accelerate publication of specific guidances for physiologic monitoring products with the assistance of the Coalition (priorities and content); b) more multidisciplinary research should be incorporated into new device studies; c) commonly accepted clinical tools may not need to be tested for clinical utility--these accepted tools should be identified by the Coalition; and d) an independent council of researchers and clinicians should make themselves available to serve as consultants to manufacturers regarding appropriate study design for the testing of devices.
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Critical care clinics · Oct 1995
ReviewSedation of the agitated, critically ill patient without an artificial airway.
One of the most demanding and stressful situations is management of the agitated, unintubated, critically ill patient. Sedation often must be provided without a specific diagnosis, and the need for rapid airway control must be anticipated. No predictably safe and effective techniques are proven. ⋯ Prolonged need for significant sedative medication usually mandates a secure airway. Once this is accomplished, the requirement for a continuously present airway expert at the bedside is removed. The standard for sedating a patient without an artificial airway requires a higher level of expertise than sedating a critically ill patient with an artificial airway.
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Recent advances in the pharmacology of sedative drugs have expanded their use in the intensive care unit. Indications and endpoints for sedation, however, often are defined poorly and are difficult to assess. ⋯ New indications for sedation have been proposed in recent years, including enforcing sleep/wake cycles, manipulating cellular metabolism, and preventing myocardial ischemia. The evidence supporting the efficacy of these new indications is not yet complete.