Articles: critical-care.
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Transfusion in the exsanguinating Jehovah's Witness patient--the attitude of intensive-care doctors.
The attitude of a Jehovah's Witness patient refusing a blood transfusion during an exsanguinating episode can raise important ethical problems. Various ethical principles, including the patient's autonomy, the sanctity of life and the dignity of the medical profession can be confronted. A total of 242 doctors, members of the European Society of Intensive Care Medicine, answered a questionnaire indicating that 63% would transfuse in those circumstances. ⋯ Only 45% considered the blood transfusion as appropriate, of whom 25% were unable to define the best option. Doctors from France and Italy more commonly transfuse while those from The Netherlands, the United Kingdom and Scandinavia more commonly withhold transfusion. These data stress the need for a definition of the appropriate medical attitudes towards the patient refusing blood transfusion.
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To ascertain the anaesthetic complications requiring post-anaesthetic respiratory support in a large obstetrical hospital, the hospital records of obstetrical patients admitted to an adjacent general intensive care unit (ICU) were studied. Obstetrical patients who required mechanical ventilation following anaesthetic complications were identified and their hospital records reviewed. In a ten-year period there were 61,435 women delivered at the Mater Mothers Hospital (MMH) in Brisbane, Queensland, Australia. ⋯ Complications included anaphylaxis, high block and failure of tracheal intubation. The incidence of a major complication of a GA causing admission to the ICU was 1 in 932 and for RA was 1 in 4177 when these were given for delivery (P less than 0.01). If a complication requiring ICU admission and mechanical ventilation is used as the criterion of safety it appears that RA is safer than a GA for delivery.
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Critical care medicine · Jul 1991
Measurement of systolic blood pressure using pulse oximetry during helicopter flight.
Monitoring of vital signs in critically ill patients during helicopter flight is difficult because of the noise and vibrations of the aircraft. We evaluated the use of a pulse oximeter to measure systolic BP intraflight. ⋯ We conclude that a pulse oximeter that displays a plethysmographic waveform can accurately measure systolic BP intraflight.
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A preliminary study was performed to calculate the cost of intensive therapy on an individual patient basis. The fixed (equipment, supporting services and land opportunity), semi-fixed (staff) and marginal (treatment) costs of 20 critically ill patients were calculated individually. The results show that there is wide variation in intensive therapy costs. ⋯ The mean total cost per patient was 1980 pounds, but the cost per survivor increased by 16% (347 pounds) because of four deaths on the intensive care unit. High total costs are associated with increased severity of illness and higher marginal (treatment) costs are associated with increased semi-fixed (staff) costs. The cost of intensive therapy was three to five times that for general ward care.
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J Burn Care Rehabil · Jul 1991
Use and efficacy of a nutrition protocol for patients with burns in intensive care.
The University of Michigan Burn Center uses a protocol to standardize the assessment, initiation, and monitoring of nutritional support for patients with burns of greater than 30% total body surface area (TBSA). Six patients with 20% to 80% TBSA burns were followed for 3 weeks to determine the effect of the protocol on the assessment, initiation, monitoring, and adequacy of nutritional support. The protocol calls for resting energy expenditure (REE) measurement within 24 hours of injury, to be repeated 3 times per week, for assessment of caloric requirements. ⋯ Overall, the six patients received enterally an average of 75% of their caloric requirements. The major reason for inadequate enteral support was interruption of tube feedings because of tube dislodgment or multiple surgical procedures. The protocol used weekly measurements of total iron-binding capacity and prealbumin level s parameters of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)