Articles: critical-care.
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Intensive care patients often require inotropic support to stabilise circulation and to optimise oxygen supply. In this context, the catecholamines norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine and dobutamine are still the mainstay of therapy. They provide, to different extents, a variety of adrenoceptor-mediated actions comprising vasoconstriction (via alpha-receptors) as well as vasodilatation (via beta 1-receptors), and an increase in cardiac output by enhancing inotropy and heart rate (again via beta 1-receptors). ⋯ Depending on the dosage and the speed of intravenous administration, the use of phosphodiesterase inhibitors sometimes results in pronounced decrease of blood pressure which may require vasopressor therapy. Other drugs including histamine H2-agonists are currently under investigation. Their value in the treatment of intensive care patients has still to be evaluated.
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Practice Guideline Guideline
Guidelines for the transfer of critically ill patients. Guidelines Committee, American College of Critical Care Medicine, Society of Critical Care Medicine and the Transfer Guidelines Task Force.
The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. ⋯ The available data has allowed the authors to develop an evidence-based practice policy for the intra- and interhospital transport of the critically ill.
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Septic shock is the host's inflammatory response to infection. There are multiple endogenous mediators responsible for the pathogenesis of septic shock. Cytokines, nitric oxide and prostaglandins are some of the major mediators. ⋯ Management of septic shock is focused in maintaining hemodynamic stability and an adequate oxygen delivery and utilization. Careful attention to each organ-system is of paramount importance to prevent complications and improve outcome. Experimental therapies to modulate the inflammatory response are promising.
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Ann Acad Med Singap · May 1993
ReviewCritical care medicine--a review of the outcome prediction in critical care.
Predicting the outcome of critically ill patients has undergone considerable evolution over the last two decades. Economic constraints require the channelling of resources and efforts to patients with reasonable chances of survival. ⋯ The issues surrounding the use of the APACHE score from the literature are discussed. Estimation of specific individual mortality risks have not been as successful as that for large groups of critical care patients in general using the available prognostic scores and until better systems are available, clinical decisions on any individual outcome should not be based on any prognostic score alone.