Articles: critical-illness.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of vecuronium administered by the Springfusor infusion device to vecuronium by intermittent bolus injection in critically ill adult patients.
To evaluate the Springfusor infusion device for clinical use in an Intensive Care Unit and to compare the technique of intermittent bolus and constant infusion of muscle relaxants, we undertook a prospective double-blind randomized placebo-controlled study. Twenty critically ill ventilated patients requiring muscle paralysis were investigated. ⋯ The device is robust, easy to use and reduces nursing workload. This may translate into cost-saving improvement in patient care if the Springfusor is used to provide muscle relaxation, sedation and analgesia.
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Comparative Study
A prospective comparison of two multiple organ dysfunction/failure scoring systems for prediction of mortality in critical surgical illness.
Multiple organ failure (MOF) is the primary cause of death in surgical intensive care units (SICU). Mortality increases with an increasing number of failed organs, but it has been recognized that lesser degrees of organ dysfunction occur commonly. Such gradations of the multiple organ dysfunction syndrome (MODS) are postulated to provide more descriptive and predictive power. ⋯ Death was equally likely for comparable degrees of organ dysfunction and failure. Mortality increased (p < 0.01, ANOVA) with higher scores in both systems. In patients with 9-12 organ dysfunction points, the number of failed organs was 1.5 +/- 0.2 in 34 survivors, versus 2.9 +/- 0.3 in the 14 nonsurvivors (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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J Pain Symptom Manage · Oct 1994
A retrospective study of risk factors of akathisia in terminally ill patients.
Akathisia is a distressing disorder that manifests as a state of restlessness and motor agitation. We aim to highlight the problem of akathisia to the palliative care physician by identifying and quantifying risk factors in the terminally ill. A retrospective case-control study was utilized to investigate risk factors for akathisia. ⋯ Other significant variables were exposure to morphine (OR, 5.3; 95% CI, 1.9-14.2), sodium valproate (OR, 2.5; 95% CI, 1.0-6.4), and sodium bicarbonate/tartrate (Ural) (OR, 4.2; 95% CI, 1.2-15.3). Highlighting factors that predispose patients to akathisia emphasizes that this syndrome should not be forgotten when treating the terminally ill. It is recommended that those drugs identified should be judicially used and carefully monitored.
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Critical care clinics · Oct 1994
ReviewPharmacology of intravenous sedatives and opioids in critically ill patients.
Many agents are available for sedation of agitated, delirious patients. In general, they should be administered intravenously to achieve a painless, more rapid, and more reliable onset of action. Proper selection of an agent requires understanding the basic principles discussed in this article, including the T-1/2 alpha and T-1/2 beta and the side-effect profile associated with each class of drugs, as well as for each agent. ⋯ Once sedation has been achieved, control usually can be maintained with continuous intravenous infusions of BNZs, perhaps in combination with a continuous infusion of an opioid or intermittent administration of a neuroleptic agent. With goal-oriented titration of the pharmacologic therapy, patients can be maintained safely in a sedate, calm state; intermittent periods of agitation, alternating with periods of severely depressed level of consciousness, can be avoided. Finally, when pharmacologic suppression of agitation and delirium is needed, the patient must be evaluated fully to determine the underlying cause of the confusional state.
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Critical care clinics · Oct 1994
Case ReportsLife and near-death in the intensive care unit. A personal experience.
Being seriously ill, even once, is an experience from which one learns a great deal. To feel the loss of control, the pain, and the worry about unfulfilled responsibilities at home and at work forever provides one with the motivation to deal with these issues when confronted with sick people. To understand that each illness has unique effects on a patient and that these patients almost always trust us, gives us the confidence to use our training and experience to do what we know is right for them. We should be confident that if these lessons are internalized and applied, patients and their caretakers will benefit.