Articles: critical-care.
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Disorders of both the central and peripheral nervous systems are important causes of respiratory insufficiency. However, simple clinical observations and pulmonary function measurements may fail to identify the location and type of disorder. ⋯ These studies have been preformed safely and with little discomfort on adults, children or infants, and in out-patient and general ward settings. We have found they are of particular value in the intensive care unit.
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Critical care medicine · May 1994
ReviewProlonged paralysis in intensive care unit patients after the use of neuromuscular blocking agents: a review of the literature.
To review the reports of prolonged neuromuscular blockade secondary to vecuronium and atracurium administration. To propose mechanisms for prolonged blockade, as well as methods to avoid prolonged blockade. ⋯ Controlled studies assessing the appropriate drug, administration method, use of drug in end-organ dysfunction, and monitoring techniques are unavailable. From the available case reports, length of neuromuscular blockade has been associated with end-organ dysfunction, concomitant drug use, severity of the underlying illness, length of therapy, monitoring techniques used, and perhaps method of drug administration. Steroidally based neuromuscular blocking agents may be particularly hazardous in patients receiving systemic corticosteroids. It is premature to determine the safety of one particular neuromuscular blocking drug in relation to another. Further studies are needed to optimize the use and safety of neuromuscular blocking agents in intensive care unit patients.
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Electroencephalography (EEG) and evoked potential studies are established monitoring tools in the neurological intensive care unit (ICU). These neurophysiologic techniques provide information on physiological state and response to therapy, and may aid diagnosis and prognosis. Serial studies or continuous monitoring may enable changes to be detected prior to irreversible deterioration in the patient's condition. ⋯ In addition, continuous EEG monitoring has revealed previously unsuspected non-convulsive seizures in one-third of patients. SEPs and BAEPs can provide useful prognostic information in coma-however, these tests are etiologically nonspecific and must be carefully integrated into the clinical situation. Motor evoked potentials offer a potentially useful tool for evaluating motor system abnormalities in the ICU.
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Clinical nursing research · May 1994
Psychophysiological responses of parents to pediatric critical care stress.
Psychological factors are associated with how parents cope during a child's intensive care hospitalization. However, little is known about the role of physiological-stress responses in parents' coping and adaptation to such situations. ⋯ Further, parents who were more problem focused performed more child care activities during the experience. The results of this study provide information for planning interventions to promote parental coping and adjustment to the child's critical care situation.
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AACN Clin Issues Crit Care Nurs · May 1994
Organizational strategies to promote research-based practice.
Research-based practice is necessary for the consistent achievement of cost-effective, quality patient outcomes. Several organizational strategies can be implemented to facilitate research-based practice. These strategies, divided into six major categories and further organized at the individual, unit, and institutional levels, are believed to be most effective when comprehensively addressed and implemented.