Articles: critical-care.
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Critical care clinics · Oct 1992
ReviewSengstaken-Blakemore tube placement. Use of balloon tamponade to control bleeding varices.
The management of acute variceal bleeding continues to challenge those who care for patients with portal hypertension. Survival depends on rapid institution of an established protocol for resuscitation, diagnosis, and management of the patient. Balloon tamponade plays an important part in the management of this problem along with pharmacologic and endoscopic modalities. It is important in closing, however, to note that guidelines for use cannot compensate for lack of experience and the authors agree with Vlavianos and colleagues in stating that without experience in its use, balloon tamponade is of limited value.
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The principles of stabilization before, and monitoring during, transportation are well established in adult intensive care practice but less so in paediatrics. The speed with which critically ill children deteriorate and the aggressiveness of treatment needed are often underestimated. A dedicated, fully funded and staffed transport service for each paediatric referral centre in the UK is urgently required.
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To investigate the relationship of locus of control, parental age, and state anxiety to parental coping and activities performed during hospitalization of a child in a pediatric critical care center. ⋯ Appropriate strategies to bolster coping and reduce stress of parents need to be constantly reassessed because coping mechanisms vary according to parental age, locus of control, anxiety level, and parental involvement in child-care activities. More research is needed in the changes of parental coping mechanisms with time and child-care activity, to assess the benefits of interventions planned to encourage a problem-focused approach.
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Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. ⋯ Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.
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Randomized Controlled Trial Comparative Study Clinical Trial
Isoflurane and propofol for long-term sedation in the intensive care unit. A crossover study.
Propofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long-term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. ⋯ Few adverse events were noted. Technological advances in the administration of volatile agents as long-term sedatives in the Intensive Care Unit may facilitate their more widespread use.