Articles: critical-care.
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Review
Withdrawing and withholding treatment in intensive care. Part 1. Social and ethical dimensions.
Intensive care is an expensive resource. The medical profession has been criticised for applying technology indiscriminately and at vast expense to a relatively small group of patients. ⋯ The appropriate response of doctors to these problems is to provide leadership in promoting public awareness and debate of the effects of rationing, and to provide rational allocation of therapy to individual patients. The major issues involving resource allocation in society and to individuals are discussed.
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Medical diagnosis and therapeutic monitoring for critical illness require adaptation of laboratory analyses to the bedside. These are greatly helped by the modification of physiological and biochemical data-acquisition techniques to increase the number and accuracy of noninvasive variables that can be obtained from the patient. ⋯ I describe a noninvasive sensor system linked to a computer work-station that functions in a pattern recognition mode to permit classification of patients as to the type and severity of their physiological adaptation. This system can serve as a sophisticated bedside monitor of the severity of the patient's condition, as a guide to therapy.
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Cardiopulmonary monitoring remains the mainstay of intensive-care unit utilization of clinical chemistry resources. Its focus has been on the restoration and maintenance of oxygen transport. ⋯ Some of the clinical chemistry technologies used include analyses for amino acids and polyunsaturated fatty acids, measurement of cytokine concentration and activity, nutritional assessment and monitoring, more sensitive monitors of liver function, and assessment of altered immunity in critically ill patients. Use of these technologies, along with specific support measures, offers new avenues for decreasing infectious complications and reducing mortality and morbidity of patients in intensive-care units.
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AACN Clin Issues Crit Care Nurs · Aug 1990
Case ReportsExtracorporeal membrane oxygenation: current use and future directions.
Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. ⋯ Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.
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AACN Clin Issues Crit Care Nurs · Aug 1990
New techniques for weaning difficult patients from mechanical ventilation.
This article compares the weaning of challenging patients from mechanical ventilation to an exercise training program experienced by many athletes. Physically, the importance of the correction and maintenance of chronic health issues, nutrition, and hydration are explored. Psychologically, the degree of preparedness by both the patient and the health care team is presented. ⋯ Newer modes of ventilation, including pressure support ventilation, mandatory minute ventilation, and continuous flow, decrease the work of breathing, promote ventilator/patient synchrony, and provide a more dynamic weaning process. All of these modes promote exercise, and augment the physical and psychological components of weaning. Nursing considerations for successful weaning are offered.