Articles: critical-care.
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Analgesia and sedation with the associated reduction of undesired vegetative reactions are important components in the therapeutic regimen of intensive care patients. None of the sedative drugs available can fulfil every one of the criteria expected of an "ideal" sedative. Four commonly used drug combinations have been established as standards: 1. opioid and neuroleptic, 2. opioid and benzodiazepine, 3. ketamine and benzodiazepine, and 4. opioid and propofol. ⋯ In some patients (e.g. those with a history of alcohol abuse) a massive increase of the drug dose is not indicated when the effect is not adequate. Instead, an entirely different substance should be employed and the administration of less frequently used drugs should be considered. Despite detailed knowledge of the altered pharmacokinetics in critically ill patients, the drugs should be dosed as dictated by the situation, true to the anaesthesiologists' adage: "Dosage according to effect!"
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Int J Clin Monit Comput · Dec 1992
A knowledge-based system for assisted ventilation of patients in intensive care units.
The procedure for weaning a patient with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long clinical practice. We designed a knowledge-based system for the management of patients receiving respiratory support and implemented a weaning procedure. The system is intended for patients whose spontaneous respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during inspiration (Pressure Support Ventilation mode). ⋯ In 10 of these patients, considered as good candidates for weaning on the strength of objective criteria, the system maintained the breathing pattern in a zone of comfort for 95% of the period of assisted ventilation and stated that they were 'weanable'. This was consistent with the clinical evolution of all 10 patients. These results show that such a system can provide effective management for mechanically ventilated patients.
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When the pregnant woman develops an acute or critical illness requiring invasive hemodynamic monitoring, it is imperative to consider physiologic changes that occur during pregnancy that impact on assessment parameters. Awareness of both the alterations in these parameters and the changes in arterial blood gas values guide nursing care that continues to support perfusion and oxygenation needs unique to pregnancy. When critical care capabilities are not available in the labor and delivery unit, the obstetric patient is most often transferred to a medical or surgical intensive care unit. In such cases, consultation with obstetric staff is warranted.
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This paper is based on consideration of the ethical issues surrounding organ donation. This emotive subject has far-reaching implications concerning both donation and transplantation but the purpose in this paper is to deal specifically with issues related to cadaveric organ donation and how they concern nurses in an intensive care unit (ICU). A brief, general description of both ethics and organ donation is followed by a discussion of the issues surrounding the donor himself, including the diagnosis of brainstem death, the donor's family, and the nursing and medical implications. Legal, social and economic factors are considered with the aim of highlighting ethical areas but not necessarily providing answers to the questions raised.