Articles: critical-care.
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Critical care clinics · Jul 1991
ReviewToxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors.
Sodium nitroprusside causes cyanide poisoning at currently recommended infusion rates. Serum thiocyanate concentrations are of no value in detecting cyanide poisoning caused by nitroprusside. Methemoglobinemia in those patients receiving intravenous nitroglycerin may seriously impair oxygen delivery and is not always accompanied by cyanosis in anemic patients. Angiotensin-converting enzyme inhibitors are responsible for a plethora of adverse effects, including renal insufficiency, hypotension, angioedema, cough, and increased insulin sensitivity.
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Colloid fluid solutions are frequently used as plasma volume expanders in the critically ill. As a group, these nonblood volume replacement solutions have in common a number of potential adverse effects. ⋯ Renal dysfunction has been associated with dextran 40, myocardial depression with albumin, hypotension with purified plasma protein, and hyperamylasemia with hetastarch. Because no ideal colloidal solution exists, knowledge of type, severity, and clinical significance of adverse effects is important in determining the appropriate plasma volume expander and monitoring its effects.
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Critical care clinics · Jul 1991
ReviewOpioids and other analgesics. Adverse effects in the intensive care unit.
Analgesics are an important component of care for critically ill patients. The agents available--opioids, anesthetics, and NSAIDs--are efficacious, but each is capable of inducing a variety of adverse effects. ⋯ Anesthetic agents and NSAIDs offer less effect on cardiovascular and respiratory function than opioids, but are not without adverse effects. A thorough understanding of analgesic-associated adverse effects and drug interactions, as well as methods for anticipating and monitoring them, can help to minimize their effect on the ICU patient.
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A major responsibility of the critical care practitioner is to assure adequate ventilation of the critically ill patient. The traditionally used methods for evaluating ventilation, such as physical examination and measurement of vital signs, are indirect. The most commonly used direct method, measurement of arterial carbon dioxide tension, is invasive and intermittent. ⋯ We review relevant respiratory physiology as a basis for understanding the value of capnography. The technology on which capnography is based is described with emphasis on methods of gas sampling, limitations of capnography, and features available on currently marketed instruments. Representative capnograms are presented and the data interpreted to enable the practitioner to determine when capnography is an appropriate monitor for the critically ill adult.
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Comparative Study
Transesophageal echocardiography in the critical care unit.
Transthoracic echocardiography may be of limited value for patients in intensive care units because of suboptimal patient positioning, surgical wounds, and mechanical ventilation. By contrast, transesophageal echocardiography provides a new window for cardiac imaging, even in critically ill patients. We report our indications based on findings comparing transesophageal and transthoracic echocardiography in 112 studies in intensive care units. ⋯ Transesophageal echocardiography was superior to the transthoracic approach in patients with significant (higher than 2+) mitral regurgitation, with improved detection in 10 (9%) cases (p less than 0.05). Transesophageal echocardiography also provided additional information in the evaluation of vegetations, diseases of the aorta, visualization of the left ventricle, intracardiac masses, intracardiac thrombi, and congenital heart disease. Transesophageal echocardiography provides a useful diagnostic tool for evaluation of critically ill patients.