Articles: critical-care.
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As of 1991, intensive care medicine in Germany is not an independent medical specialty but a part of other main medical specialities such as anesthesiology, internal medicine, surgery, and pediatrics. Accordingly, there is neither formal training nor a separate board examination in intensive care medicine. ⋯ Surgical (or operative) ICUs predominantly are operated by anesthesiology departments, as anesthesiologists' expertise in respiratory and hemodynamic support qualifies them for the management of the critically ill patient in the perioperative phase. This article gives a brief review of the development of intensive care medicine in Germany, thereby providing the historical background for its present national and regional organization, facilities, and education and training programs.
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In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. ⋯ These problems and others make the immediate perioperative period particularly challenging. With aggressive management, however, the probability of a successful outcome can be enhanced.
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Review Randomized Controlled Trial Clinical Trial
Continuous lateral rotational therapy and nosocomial pneumonia.
The adverse effects of prolonged immobility are due primarily to gravitational effects on blood flow and ventilation, impairment of the normal mucociliary escalator and possibly an increase in extravascular lung water. However, CLRT theoretically should reverse these abnormalities. The sequence of events that culminate in LRTI or pneumonia is unclear; however, low tidal volumes, increased extravascular lung water and the accumulation of bronchopulmonary secretions may lead to atelectasis, a well-known precursor of pneumonia. ⋯ The prevention of pneumonia and more rapid transfer from the ICU should offset the additional expense of a specialized bed. The data suggest that a multicenter study with accrual of a large number of patients to evaluate this form of therapy in a prospective, randomized study is necessary. If the hypothesis that CLRT decreases the incidence of nosocomial pneumonia in the ICU is proven, the impact on critical care in the 90s would be substantial.
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Critical care medicine · May 1991
Efficacy and safety of potassium infusion therapy in hypokalemic critically ill patients.
To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients. ⋯ In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dose-dependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration.
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AACN Clin Issues Crit Care Nurs · May 1991
Strengthening nurse-family relationships in critical care.
Establishing relationships with families in critical care is an essential part of high quality care. Critical care nurse-family relationships are important to the patient and family and also benefit the nurse. Thus, nurse-family relationships should be started when families first enter the critical care environment. ⋯ Essential qualities of successful relationships include: trust, respect, empathy, warmth, sensitivity, and touching, when appropriate. Each of these qualities is dependent on the verbal and nonverbal skills of the critical care nurse. As with anything worthwhile, relationship skills take practice to develop, involving a commitment to the importance of nurse-family relationships in critical care.