Articles: critical-care.
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Clinical Trial
[The determination of total protein is not a suitable diagnosis for the treatment of hypoalbuminemia in intensive care patients].
In clinical practice, the administration of supplementary albumin often depends on the measured plasma concentration of total protein (TPC). A TPC of less than 5 g/dl is generally accepted as an indication for albumin therapy, assuming an albumin concentration of less than 2.5 g/dl. However, a physiological relation between TPC and albumin cannot be expected in critically ill patients, and thus, measurement of TPC may be misleading as an indicator for the use of albumin. ⋯ In other cases, a need for albumin would be assumed from a reduced TPC even though the albumin concentration still exceeded 2.5 g/dl. Therefore, determination of TPC is not a suitable indicator of the need for albumin replacement. As a result, we suggest routine determination of albumin concentrations instead of TPC.
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Forty consecutive patients who could not be weaned from mechanical ventilation in the intensive care unit (ICU) entered a multidisciplinary progressive care programme (PCP). The mean number of hours per day of ventilatory support was 19.9 at the time of transfer but only 6.7 at discharge. ⋯ Seventy-six percent were alive 1 yr after discharge and 80% of patients were discharged directly from the PCP to their homes. Mental and emotional scores in a quality of life questionnaire (SF 36) were normal, but physical function remained limited.
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Comparative Study
Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff.
To identify a series of variables which predict death after in-hospital cardiopulmonary resuscitation (CPR). ⋯ The CPR outcome can be predicted early during hospital course, which may assist physicians to formulate a do-not-resuscitate order. Patients surviving a CPR should be considered candidates for another resuscitation if clinically warranted. Low-risk patients can safely be admitted to telemetry units instead of to more costly ICUs.
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Computerized EEG (CEEG) monitoring has recently been introduced to intensive care units (ICU). Unlike the intermittent assessment using coma scales, CEEG monitoring provides continuous information about a patients' neurological condition. Patient status can be monitored more accurately with CEEG. ⋯ The goal of continuous CEEG monitoring is to recognize a decline in a patient's condition before physical signs and symptoms are present. The neuroscience nurse participates in the assessment of the EEG recording as well as in evaluating therapy. This article introduces the neuroscience nurse to the basic terminology, rationale for use and clinical application for continuous computerized EEG monitoring.