Articles: critical-care.
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Neuromuscular blocking agents (NMBAs) are used in critical illness to reduce metabolic demands and prevent ventilator asynchrony in patients refractory to sedation and anxiolysis. Concurrent interventions for patients receiving neuromuscular blockade include many factors related to prevention, maintenance, and monitoring during immobilization. Prevention interventions include skin care, turning regimes, physical therapy, eye care, and pulmonary toilet to prevent atelectasis, pneumonia, skin breakdown, and corneal ulceration. ⋯ Cost of therapy is influenced by preventing the side-effects of immobility, the choice of NMBA, and concurrent drug therapies, as well as by titration of the NMBA to the lowest drug dose possible to obtain clinical end-points. Clinical end-points are individualized by the prescribing physician and may range from "no movement" to "movement acceptable but no evidence of spontaneous respirations" to "movement acceptable but no ventilator asynchrony." Whenever "no movement"c is identified as the goal, a nerve stimulator is used to identify the depth of paralysis and prevent accidental surplus drug administration, which may result in prolonged paralysis. Methods for using the nerve stimulator and troubleshooting techniques are discussed.
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The practice of critical care medicine has progressed dramatically over the past several decades. With the advent of new pharmacological therapies and technological interventions, our ability to manage a multitude of pathophysiologic conditions has grown. ⋯ Associated with new therapeutic and diagnostic interventions are secondary side effects and complications. It is often the undesired sequela of all interventions that forces clinicians to periodically reevaluate to whom, why, how, and when we employ new drugs or procedures.
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Critical care medicine · Feb 1994
Attitudes of critical care medicine professionals concerning distribution of intensive care resources. The Society of Critical Care Medicine Ethics Committee.
To determine critical care practitioners' attitudes about the importance of various factors in decisions to use intensive care, including age, prognosis, quality of life, patient preference, and medical condition. ⋯ These results suggest that critical care providers, who must occasionally face difficult decisions about how to distribute limited resources among patients with competing needs, were not often inclined, at the time of this survey, to make choices based on estimates of who might benefit most. These critical care physicians' attitudes about triage may not support the optimal use of critical care resources.
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Critical care medicine · Jan 1994
Optimal sedation of mechanically ventilated pediatric critical care patients.
To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. ⋯ Adequacy of sedation is measured more consistently by observers using the COMFORT Scale than by intensivist global assessment.