Articles: critical-care.
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Critical care clinics · Jul 1991
ReviewNeuromuscular blocking agents and sedative drugs. Clinical uses and toxic effects in the critical care unit.
The use of sedatives and muscle relaxants is common in the ICU. Therapeutic goals should be carefully established. Monitoring of desired effects and toxic side effects is essential to avoid preventable morbidity.
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Nurses have access to continuous SvO2 monitoring as one parameter for evaluating the hemodynamic status in critically ill patients. The research studies on SvO2 monitoring have demonstrated inconsistent results regarding the utility of SvO2 as an assessment tool. Hence, it is necessary to carefully review these research findings for their impact on nursing practice. Nurses must be aware of the possibility of overreliance on continuous SvO2 monitoring and of the limitations of the SvO2 measurement itself.
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This article is the second of two parts outlining the objectives for resident rotations in intensive care units. It is part of a larger continuing series on the goals and objectives to direct the training of emergency medicine residents on off-service rotations. ⋯ Critical care medicine is a natural continuum of emergency medicine, and provides the resident with the ability to follow the natural progression of seriously ill patients, as well as build confidence and experience in caring for the critically ill and injured. These objectives are designed to help focus the resident's reading and study during the rotation.
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Comparative Study
A comparison of intensive care unit care of surgical patients in teaching and nonteaching hospitals.
Three hundred forty-eight teaching (TH) and 282 nonteaching (NTH) hospitals were surveyed to determine how intensive care unit (ICU) care is delivered to surgical patients and current views on surgical critical care. Teaching hospitals were more likely than NTHs to have a separate surgical ICU (92% versus 37%), a dedicated ICU service/physician (37% versus 7%), and a surgeon as director of the ICU (67% versus 29%). All THs and 33% of NTHs provided 24 hour in-house coverage for the ICU. ⋯ Many (THs, 45%; NTHs, 33%) thought that surgeons are willingly relinquishing ICU care. Surgeons continue to desire responsibility for their patients in the ICU and most prefer ICU service involvement provided by surgeons. This discrepancy between what is practiced and what is desired, along with proposed changes in reimbursement for surgery and the recent definition of critical care as an essential part of surgery, may stimulate greater involvement of surgeons in critical care.
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Clinical endocrinology · Jul 1991
Critically ill patients have high basal growth hormone levels with attenuated oscillatory activity associated with low levels of insulin-like growth factor-I.
The aim was to study the relationship between growth hormone (GH) and insulin-like growth factor-I (IGF-I) in critically ill patients. ⋯ We have demonstrated that critically ill patients have low IGF-I levels associated with augmented baseline GH levels which show reduced oscillatory activity. The results would be compatible with the hypothesis that there is an adaptive change in critically ill patients away from the indirect effects of GH (stimulation of IGF-I production and anabolism) and toward the direct effects (lipolysis and insulin antagonism) which increase the availability of energy substrates. The pattern of GH levels seen in our patients may be important in this adaptation.