Articles: critical-care.
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Intensive care is increasingly used in the management of cancer patients. The main reasons for admitting a cancer patient to an intensive-care unit are postoperative recovery, critical complications of the cancer disease and its treatment, the administration and monitoring of intensive anticancer treatment, and acute disease unrelated to cancer or its treatment. The present review is focused on the prognosis of critically ill cancer patients, on the description of the types of complications requiring intensive care, on specific aspects of the application of critical-care techniques in cancer patients, on ethical considerations and on ICU organization in the context of oncology.
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Propofol is commercially available as Disoprivan. It is formulated as an aqueous emulsion with 1% 2,6-diisopropylphenol, 10% soya bean oil, 2,5% glycerol and 1.2% egg phosphatide. Since 1986, propofol has been used as a sedative drug in the ICU and is highly valued for its numerous positive qualities. ⋯ First, cardiovascular depression, especially if potentiated by drugs such as beta- and Ca-entry blockers, may lead to hypotensive episodes. Potential problems (drug tolerance, hypertriglyceridaemia) may be revealed in long-term studies. As long as no such studies have been presented, the authors believe that it is too early to consider propofol the ideal drug for long-term sedation.
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Southern medical journal · Mar 1995
Case ReportsPentobarbital sedation for patients in the pediatric intensive care unit.
We present our experience with pentobarbital for sedation during mechanical ventilation in six infants when fentanyl and midazolam failed. The patients ranged in age from 2 to 17 months and in weight from 3.0 to 11.4 kg. Before the switch to pentobarbital, the maximum doses of fentanyl ranged from 7 to 13 micrograms/kg/hr and the midazolam infusions, from 0.2 to 0.4 mg/kg/hr. ⋯ In the four patients who required neuromuscular blocking agents, their use was discontinued after pentobarbital was given. The antihypertensive agents (diazoxide and nitroprusside) required by the two patients receiving extracorporeal membrane oxygenation were also discontinued after pentobarbital administration. Although we continue to use fentanyl and benzodiazepines as first-line drugs for sedation, pentobarbital may be an effective alternative when these agents fail.
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Journal of critical care · Mar 1995
ReviewPrevention of drug-induced nephrotoxicity in the intensive care unit.
Acute renal failure (ARF) occurs in 5% to 25% of all admissions to an intensive care unit (ICU). The development of ICU-associated ARF increases the average mortality from about 15% to more than 60%. ⋯ Recent studies suggest that a significant percent of hospital-acquired ARF is caused by nephrotoxins. This brief review will discuss the frequency of occurrence, pathophysiology, risk factors, clinical course, and prevention of nephrotoxicity that may occur after exposure to aminoglycosides, nonsteroidal anti-inflammatory drugs, and radiographic contrast agents.
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Journal of critical care · Mar 1995
Comparative StudyEnhancement of neutrophil function by in vivo filgrastim treatment for prophylaxis of sepsis in surgical intensive care patients.
To determine the kinetics of leukocyte counts and of oxygen radical production of neutrophils from postoperative/posttraumatic patients with or without infusion of filgrastim (recombinant human granulocyte colony-stimulating factor, rhG-CSF) as prophylaxis against sepsis. ⋯ Prolonged enhancement of neutrophil count and function induced by rhG-CSF may be useful in the prophylaxis of sepsis in posttraumatic/postoperative patients at high risk of sepsis.