Articles: critical-care.
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Cerebral lesions of variable severity lead to systemic and intracranial reactions. These create secondary brain damage due to hypoxia and ischemia. The causes as well as the sequelae of secondary brain damage necessitate long-term intensive care treatment with high technical and personal expenditure. ⋯ The decision to limit treatment should be based on the numerous national and international statistical models and discussed on an individual basis, excluding even a 5% chance of survival. Early information of the family on the probable prognosis is useful. Their participation in the process of decision can be assessed only on an individual basis.
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Clin Intensive Care · Jan 1994
Case ReportsProviding psychological support for patients after critical illness.
The majority of patients have little or no memory of their stay in ICU or remember only pain, suctioning or lack of sleep. Dreams and nightmares while in the intensive care unit (ICU) and after discharge home have also been reported. The few studies investigating the longer-term psychological problems of critical illness point to a picture of social isolation with patients avoiding company and showing less affection to their partners. ⋯ Two case histories give an illustration of the type of problems ICU patients experience during their recovery and how an informal support group can help. In addition to possible benefits to the patients, support groups can also give ICU staff a chance to understand the process of recovery from critical illness and to examine the effects on patients of their own practice. However, they must also have enough insight to know when a patient needs professional help; for example, a patient displaying symptoms of post-traumatic stress disorder should be referred, with their agreement, to a clinical psychologist.
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Ann Fr Anesth Reanim · Jan 1994
Meta Analysis[Selective digestive decontamination in patients under reanimation].
Nosocomial infections increase morbidity and mortality in hospitalized patients. ICU patients are at high risk of sustaining them, due to the high rate of invasive procedures and their poor health state. Conventional methods for decreasing the incidence of infection in ICU patients include handwashing, catheter care, strict antibiotic policy, and reduction of environmental sources of infection. ⋯ This benefit is most obvious in trauma patients, severely burned patients and after orthopic liver transplantation. Several studies reported a significant decrease in the overall rate of infections, especially extrapulmonary infections, including blood, urinary tract, wounds, abdominal, and catheter related infections. Despite a major decrease in infection rates with SDD, most studies did not show lowered mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)
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The treatment and outcome of the respiratory failure decisively depend on its pathophysiological background. Besides simple blood gas analysis the investigation of the respiratory mechanics, interstitial lung water and the monitoring of the pulmonary pressure are necessary for an exact diagnosis. As a scoring method of lung failure the classification by Murray and Morell is most common. ⋯ New methods as negative pressure ventilation, extracorporeal lung ventilation and liquid or partial liquid ventilation are not common yet and should be used only under special conditions. As a supplement of these modes of ventilation the application of prostacyclins, nitric oxide, surfactant and inhibitors of the arachidonic pathway is under clinical investigation. A limitation of the treatment of lung failure should be considered in irreversible multiple organ failure.
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Proc Annu Symp Comput Appl Med Care · Jan 1994
Ethical implications of standardization of ICU care with computerized protocols.
Ethical issues related to the use of computerized protocols to control mechanical ventilation of patients with Acute Respiratory Distress Syndrome (ARDS) are identical to the ethical issues surrounding the use of any therapy or intervention. Four ethical principles must be considered: nonmaleficence, beneficence, autonomy, and distributed justice. The major ethical challenges to computerized protocol use as a specific application of clinical decision support tools are found within the principles of nonmaleficence and of beneficence. ⋯ Clinicians are thus deprived of the knowledge necessary to define benefit and are limited to beneficent intention in clinical decisions. Computerized protocol controlled decision making for the clinical management of mechanical ventilation for ARDS patients is ethically defensible. It is as well supported as most ICU therapy options.