Articles: critical-care.
-
Aging (Milan, Italy) · Aug 1995
Comparative StudyOutcome of elderly patients requiring ventilatory support in intensive care.
The objectives of the study were: 1) to evaluate mortality in elderly patients requiring ventilatory support in Intensive Care Unit (ICU) and at 6, 12 and 18 months after discharge from ICU; 2) (main objective) to determine predictors of mortality in ICU and after discharge; and 3) to assess the life-style of survivors. One hundred and ten consecutive hospitalized patients > or = 70 years were included in this retrospective study. Follow-up evaluation was conducted by telephone interview. ⋯ Residence, health status, and self-sufficiency were evaluated after discharge. 1) Mortality in ICU and at 6, 12 and 18 months after discharge was 38%, 60%, 63% and 67% respectively. 2) The predictors of mortality in ICU were admission in shock, and use of major therapeutic interventions. Predictors of mortality at 6 months were admission in shock, previous impaired health status and marital status. 3) Eighteen months after discharge 92% of the surviving patients (N = 33) had the same residence, 75% had the same health status, and 78% had the same autonomy compared with pre-admission status. We concluded that shock and previous health status but not age are predictors of short- and long-term prognoses in elderly patients hospitalized in ICU for mechanical ventilation.
-
The objective of this study was to determine whether an educational intervention on medical ethics offered during a surgical intensive care unit (SICU) rotation could effect meaningful change in a tertiary SICU. ⋯ We conclude that through offering a clinical ethics program during the SICU portion of the residency training, residents increased knowledge and skill in addressing and integrating practical ethical issues into their surgical resident practice. In addition, patient care directly improved with an associated reduced SICU LOS and reduced cost.
-
The future direction of neuromuscular blockade (NMB) in critical care will be characterized by prudent utilization and quality monitoring. With the potential for persistent paralysis and less than optimal outcomes, this direction makes sense. Prudent utilization can be further defined as exhausting other therapies prior to NMB utilization. ⋯ Quality monitoring requires that peripheral nerve stimulator (PNS) monitoring become the standard for monitoring the administration of NMB agents and also that monitoring be accurate. Inherent to prudent utilization and quality monitoring is an adequate knowledge related to all aspects of NMB. The purpose of this article is to provide the necessary knowledge base for practitioners to understand normal and altered neuromuscular junction function, perform accurate PNS monitoring, and titrate NMB therapy according to the individual and desired response.
-
Anesthesia and analgesia · Aug 1995
Quantification of thrombelastographic changes after blood component transfusion in patients with liver disease in the intensive care unit.
Thrombelastography (TEG) can be used to monitor hemostasis and guide transfusion therapy during orthotopic liver transplantation. However, data are limited regarding the type and quantity of blood components necessary for TEG-guided blood component transfusion in coagulopathic critically ill patients with liver disease. We evaluated changes in four thrombelastogram variables (reaction time, thrombin constant time, alpha angle, and maximum amplitude) in whole blood samples after 74 separate blood component transfusions in 60 critically ill patients with a coagulopathy and liver disease. ⋯ Each unit of platelets decreased the reaction and thrombin constant time by 0.43 (P < 0.05) and 0.82 (P < 0.005) min, respectively, increased the alpha angle by 1.5 degrees (P < 0.005), and the maximum amplitude by 1.4 mm (P < 0.005). In patients who received multiple blood components, cryoprecipitate decreased the thrombin constant time by 0.56 min/U (P < 0.05), and each unit of platelets decreased the thrombin constant time by 0.39 min (P < 0.005), and increased the alpha angle and maximum amplitude by 0.63 degrees (P < 0.05) and 0.99 mm (P < 0.005), respectively. We conclude that platelet transfusions, alone or in combination with other blood components, are most effective for improving abnormal TEG variables in coagulopathic critically ill patients with liver disease.
-
Neuromuscular blocking agents (NMBAs) are used to facilitate mechanical ventilation in critically ill patients. Individual NMBAs differ in their metabolism and elimination, side effects, and duration of action. These differences help designate which NMBA has the greatest efficacy, given different scenarios. A common theme with all NMBAs is their ability to ablate spontaneous breathing; hence, vigilant cardiopulmonary monitoring is warranted when NMBAs are used.