Articles: critical-care.
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Critical care medicine · Feb 1979
Staff attitudes towards the care of the critically ill in the medical intensive care unit.
In an attempt to study the basis for conflict and tension surrounding decision making in ICU settings, a questionnaire was used to examine staff attitudes in a newly opened medical ICU in four major areas: (1) ethical issues; (2) decision-making process; (3) communications; and (4) emotional reactions of staff. All of the 36 house officers and 32 of 34 nurses (all RNs) completed the questionnaire. Results showed there was no monolithic nursing as opposed to physician position on any issue. ⋯ There was remarkable agreement between physician and nurse groups on ethical issues. However, nurses were less satisfied with the decision-making process and communication in the medical ICU and were more aware than physicians of their own and other's emotional reactions. The results suggested four ways to reduce tension in the medical ICU: (1) frankly recognize the inevitability of conflict and tension in a system where physicians have ultimate authority; (2) avoid perpetuating stereotypes; (3) maximize the continuity of physician care; and (4) maximize communication between and within professional groups.
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Anesth Analg (Paris) · Jan 1979
Comparative Study[Computers in intensive care units (author's transl)].
The increasing amount of physiological data which is required to be stored and displayed has created a need for computers in Intensive Care Units. Small computerised units are now available with three main advantages: 1. ⋯ The use of new programmes without having to change the unit. These systems are reliable, providing the quality of the input signal is adequate.
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Definition of the appropriate therapeutic goals for physiologic monitoring of patients postoperatively was approached by analyzing more than 50,000 values of the 20 most commonly monitored variables in a series of 113 critically ill patients throughout their immediate postoperative course. In general, normal values were poor criteria for monitoring, since normal values were restored in an average of 75 per cent of the survivors and 76 per cent of the nonsurvivors for the five most frequently measured variables; that is, arterial pressure, heart rate, central venous pressure, wedge pressure and cardiac output. ⋯ The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures. However, normal values were satisfactory for arterial pressure, peripheral resistance, pH, mixed venous oxygen tension and arterial carbon dioxide tension, largely because of the biphasic patterns of these variables.