Articles: critical-care.
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The pharmacokinetic disposition of aminoglycosides in critically ill patients with sepsis was studied. In an open-label study of the disposition of gentamicin and tobramycin, individualized pharmacokinetic values of 100 critically ill patients in the surgical intensive-care unit were compared with those of a concurrently monitored group of 100 surgery patients who were not critically ill. The a priori computer-predicted dosage requirements of the critically ill patients were also compared with the dosages derived from their individualized pharmacokinetic values, and intrapatient variation in the critically ill patients was studied. ⋯ The a priori computer predictions for the critically ill patients were significantly lower than the individualized values for V, CL, dose, and amount of drug per 24 hours. The dosing regimen from the a priori model was the same as the individualized regimen in only 2/100 patients. In the 76 critically ill patients who had a second pharmacokinetic analysis performed, there was a significant decrease in k and CL from the first analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pediatr. Clin. North Am. · Feb 1987
ReviewCerebrospinal fluid shunts. Evaluation, complications, and crisis management.
This article describes commonly used shunt systems and the simple methods that can be used to identify them. Evaluation of shunt system function, definition of site of shunt dysfunction, and immediate intracranial decompression therapy are discussed. Other complications of CSF shunt therapy and their treatments are also presented.
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Critical care clinics · Jan 1987
ReviewNutritional support in the critically ill patient: if, when, how, and what.
Nutritional support in the critically ill patient should be instituted as soon as it is clear that the patient will not eat within a week, whether the patient is at that particular time malnourished or not. The preceding discussion demonstrates that it is more a question of clinical judgment than of sophisticated nutritional assessment techniques, as most of these prove unreliable in the critically ill. However, muscle function testing seems to be promising in that regard, but more studies are required in the injured and septic patient. ⋯ We recommend the use of 1.0 to 1.5 g/kg IBW/day of a balanced amino acid preparation. The use of BCAA-enriched solutions should await confirmation of the efficacy of these solutions in randomized prospective trials. Finally, it is our belief that critically ill patients should not receive more than 1.3 times their Harris-Benedict energy expenditure, and that this energy should be provided in the form of a glucose-fat mixture (50-50 system).