Articles: critical-care.
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Septic shock, with its associated high morbidity and mortality, has long been a challenge to the critical care nurse. A promising new development in the treatment of this condition is the use of monoclonal antibodies to inactivate two prime mediators that induce the cascade of events that culminate in septic shock and multiple organ failure: bacterial endotoxin and tumor necrosis factor (TNF). The effectiveness of this immunotherapy depends on its timely administration, which necessitates the early identification of sepsis.
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We describe an audit system used in our Medical/Surgical Intensive Care Unit (ICU) during 1989-90. The system emphasizes the integration of data acquisition (database function) with the analysis and use of data (decision function). Resource input (human and technological) included patient demographics, diagnoses, complications, procedures, severity of illness (Apache II), therapeutic interventions (TISS), and nursing workload (GRASP and TISS). ⋯ Limitations of this audit system included the delay (6-9 mos) from ICU admission until data entry, the large number of diagnostic groups in the ICD.9. CM classification, and lack of a documented cause/effect relationship between interventions and complications. This audit system was more useful for utilization management than for quality assurance purposes.
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Critical care medicine · Mar 1992
Attitudes of critical care medicine professionals concerning forgoing life-sustaining treatments. The Society of Critical Care Medicine Ethics Committee.
To evaluate the attitudes of critical care professionals concerning forgoing life-sustaining treatments in critically ill patients. ⋯ Critical care professionals evaluate both the preservation of life and quality of life in their patients. Despite some discomfort in forgoing treatment, the majority of critical care professionals decide to forgo treatment in irreversibly, terminally ill patients.
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To determine why and how sedatives and analgesics are ordered and administered during the withholding and withdrawal of life support from critically ill patients. ⋯ Large doses of sedatives and analgesics were ordered primarily to relieve pain and suffering during the withholding and withdrawal of life support, and death was not hastened by drug administration.
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Randomized Controlled Trial Clinical Trial
Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients.
Suppression of the gut luminal aerobic flora to reduce nosocomial infections was tested in a prospective, randomized, double-blind, placebo-controlled clinical trial in patients in a surgical intensive care unit who had persistent hypermetabolism. Forty-six patients were randomized to receive either norfloxacin, 500-mg suspension every 8 hours, together with nystatin, 1 million units every 6 hours, or matching placebo solutions administered through a nasogastric tube within 48 hours of surgical intensive care unit admission. Selective gut decontamination with the experimental therapy or placebo solutions continued for at least 5 days or until the time of surgical intensive care unit discharge. ⋯ All other therapy was given as clinically indicated, including systemic antibiotics. The selective gut decontamination group experienced a significant reduction in the incidence of nosocomial infections and a reduced length of stay. However, these results were not associated with a concomitant decrease in progressive multiple organ failure syndrome, adult respiratory distress syndrome, or mortality.