Articles: critical-care.
-
The decision for timing of tracheostomy remains controversial. The relative complication rates in two retrospective series, in which 79 and 150 critically ill patients were examined, respectively, showed increased incidence of late complications with tracheostomy and led Petty's group to conclude "The value of tracheotomy when an artificial airway is required for periods as long as 3 weeks is not supported by data obtained in this study."
-
Thirteen critically ill patients received flumazenil after multiple doses, or an infusion, of midazolam was used as part of a sedation regimen to facilitate intensive care. All patients remained excessively sedated after the midazolam was stopped for 6 hours or longer. ⋯ The dose of flumazenil required each hour was less than estimated previously; this indicates that it may be subjected to similar alterations of elimination as those described for midazolam. Flumazenil appears to be a useful drug for the reversal of prolonged benzodiazepine sedation but repeated bolus doses or an infusion are needed if significant accumulation of benzodiazepines has occurred.
-
Pregnancy-associated admissions to the Intensive Care Unit during the first 5 years of a newly established teaching hospital obstetric unit are reviewed. There were 23 such admissions; in the same period, 21,983 deliveries occurred. ⋯ Most patients required admission for less than 48 hours. Two patients died during the period of study.
-
Nutritional therapy in the head-injured patient is designed to prevent catabolism of lean body cell mass; minimize specific and potential complications; and assist the patient to return to normal nutritional status. Prompt nutritional support accompanied by physical therapy can enhance long term rehabilitation. The critical care nurse plays a major role in this process by providing nutrition along with hemodynamic and neurologic stabilization.
-
Optimal recovery of the critically ill elderly patient depends on an adequate nutritional state. Preventing and treating malnutrition is fundamental to the provision of good patient care, yet providing nutritional support to the critically ill elderly is challenging. ⋯ As the critically ill elderly population continues to grow, more specific assessment parameters need to be identified so that the elderly person's response to different nutritional therapies will be understood better. Carefully documented and published case studies will enrich the understanding of nutritional support in this vulnerable group of patients.