Articles: critical-care.
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The intensive care unit is set apart from other hospital patient care areas by (1) physiological instrumentation that permits better assessment and more effective therapy and (2) more intensive nursing. These capabilities allow nurse and physician intensivists to evaluate tissue perfusion and tissue oxygenation by the temporal patterns of oxygen delivery and oxygen consumption, as well as hemodynamics. ⋯ Using artificial intelligence-based systems, complex clinical algorithms--tailored to specific patient conditions--have been developed and are described. These algorithms are based on both invasive and noninvasive monitoring systems and on clinical experience with a large series of high-risk surgical patients.
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Historical Article
New nurses, new spaces: a preview of the AACN History Study.
This article previews selected findings of the American Association of Critical-Care Nurses History Project that is being conducted under the auspices of the Center for the Study of the History of Nursing at the University of Pennsylvania. Using methods of social history research, we reviewed pertinent literature, studied documents of institutions and organizations, and interviewed a broad array of participants. ⋯ We explored the effects of changing public and professional ideas about the nature of critical illness, the effects of technology, and the historical dimensions of critical care nursing. Special attention was given to the events and circumstances that led to the development of AACN and the reciprocal relationships between AACN and the care of critically ill people.
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Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of the transport process go a long way toward safer transfers of the critically ill.
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To discuss the relative merits and limitations of living wills and the durable power of attorney for health care. ⋯ We recommend the execution of both a living will and a durable power of attorney for health care to provide the best assurance that patients' desires concerning medical treatments will be respected.
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J. Antimicrob. Chemother. · Jul 1992
Randomized Controlled Trial Clinical TrialA controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection.
Nosocomial infection is a major problem in intensive therapy units (ITUs) and a significant cause of mortality. Selective decontamination of the digestive tract (SDD) has been advocated as a means to reduce ITU morbidity and mortality. Ninety-one patients in a general ITU underwent SDD, consisting of topical polymyxin E, tobramycin and amphotericin B administered throughout the unit stay together with parenteral ceftazidime for the first three days, and were compared with 84 historical and 92 contemporaneous control patients who were treated conventionally. ⋯ Screening specimens revealed a significantly higher rate of colonization with resistant Acinetobacter spp. in the contemporaneous control than in the other two groups of patients; infection caused by resistant bacteria did not occur. SDD did not lead to a significant reduction in the use of systemically-administered antibiotics when compared with either control group. SDD may be used selectively in an ITU without ill effects on those patients not receiving SDD; nevertheless, microbiological monitoring is needed to detect emergence of resistant bacteria in the unit.