Articles: critical-care.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewUse of patient-controlled analgesia with critically ill patients: a risk/benefit analysis.
Patient-controlled analgesia (PCA), a system by which patients self-administer intravenous doses of narcotics using specially programmed infusion pumps, has been used for pain management in acute care settings for nearly two decades. The safety and effectiveness of PCA has been documented in many acutely ill patient populations. ⋯ However, intravenous narcotics of any type can provoke hemodynamic or respiratory complications in these compromised patients. Nursing expertise is a key factor in the successful implementation of PCA in critically ill patients.
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AACN Clin Issues Crit Care Nurs · Nov 1991
ReviewEfficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care.
Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. ⋯ Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.
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To examine the differential effect of stress ulcer prophylaxis on overt bleeding, clinically important bleeding, and mortality in critically ill patients. ⋯ Overt gastrointestinal bleeding in critically ill patients is reduced by prophylaxis with antacids or histamine-2-receptor antagonists. Histamine-2-receptor antagonists are more effective than antacids at decreasing overt bleeding and are more effective than no treatment at reducing the incidence of clinically important bleeding. Mortality rates in the intensive care unit are not decreased by stress ulcer prophylaxis.
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Ugeskrift for laeger · Oct 1991
Review[Capnometry. Technique and clinical use in anesthesia and emergency medicine].
By capnometry is understood measurement of carbon dioxide in the expiratory air. The concentration can be determined by various forms of spectometry. A new acoustic principle of measurement is more sensitive than the methods hitherto employed. ⋯ In addition, capnometry is a valuable aid in the regulation of mechanical ventilation. Recent investigations suggest that capnometry can be employed to confirm or refute clinical suspicion of pulmonary embolism and that measurement of expired carbon dioxide may be of prognostic value in resuscitation. It has not yet be elucidated whether nasal measurements in patients who are not intubated can provide reliable values.