Articles: critical-care.
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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.
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Cognitive impairment is a significant health problem for the critically ill aged and warrants further investigation. Despite the lack of knowledge of all aspects of cognitive impairment, much can be undertaken to improve the care of impaired patients. ⋯ To carry out such assessments, modification of existing tools, such as the MMSE, may be necessary. Only through such assessment, however, is it possible to detect, prevent, or treat changes in cognition, and thereby prevent its sequelae.
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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.
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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.
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This article summarizes the theoretical basis and practical applications of the fluid management of shock in critically-ill patients. It also draws attention to the differences in the aetiology and management of fluid disturbances in adult and paediatric practice. Some evidence suggests that colloidal solutions alone may be superior to crystalloid solutions alone in the resuscitation of patients with shock, but in most situations a combination of both types of fluid is more logical.