Articles: critical-care.
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Critical care medicine · Sep 1995
Practice Guideline GuidelinePractice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine.
The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. ⋯ A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
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Critical care medicine · Sep 1995
Practice Guideline GuidelinePractice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine.
The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. ⋯ A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
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Critical care medicine · Sep 1995
Comparative StudyIntrahospital transport of critically ill pediatric patients.
To determine the frequency of adverse events during intrahospital transport; to determine the requirement of therapeutic interventions during transport; to test the hypothesis that adverse events that occur during intrahospital transport are due to the transport process itself; and to determine the factors that predict the occurrence of adverse events and the requirement of major therapeutic interventions during transport. ⋯ Serious physiologic deterioration occurs during intrahospital transport of critically ill children. Severity of illness and the duration of transport are associated with the occurrence of adverse events during transport. The team composition and equipment required on transport must be commensurate with the pretransport severity of illness and the anticipated duration of transport.
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Although it is well known that pressure ulcers are associated with negative patient outcomes and increased hospital cost, there is little research related to pressure ulcers in an intensive care unit population. ⋯ The results suggest that a cut-off score on the Braden Scale could be specific to an intensive care unit trauma population.
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Anesthesia and analgesia · Sep 1995
Comparative StudyAnesthesiology critical care medicine fellowship training.
Anesthesiology critical care medicine (ACCM) fellowship training was accredited in 1989, and a small number of graduating anesthesiology residents pursue this additional training. Considering the flexible program guidelines of the American Board of Anesthesiology (ABA), we hypothesized that ACCM fellowship training programs varied significantly among the 42 institutions accredited to offer this program. This study of ACCM fellowship programs used a six-part, 57-item questionnaire completed by 36 program directors to describe six aspects of the program: institution size, program director, attending staff, fellowship applicants, curriculum, and the role of the American Society of Critical Care Anesthesiologists (ASCCA). ⋯ Fellowship curricula had varied requirements for research, intraoperative anesthesia, and ICU procedures performed by the fellow. In general, program directors believe that salary and on-call responsibility are not important issues for applicants. Nineteen percent of program directors train ACCM fellows longer than the 12 mo required by the ABA and believe that ACCM training should be lengthened.