Articles: critical-illness.
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Comparative Study
Clinical validation of a radionuclide detector to measure ejection fraction in critically ill patients.
The use of a new non-imaging nuclear probe (Cardioscint) capable of continuous online monitoring of left ventricular function is described in critically ill patients undergoing mechanical ventilation. Ejection fraction, measured by the Cardioscint, was compared with that measured by echocardiography. ⋯ Examples of fluid loading and inotropic support showed comparable changes in stroke counts measured by the Cardioscint and stroke index measured by thermodilution. The Cardioscint is a practical bedside method for continuous or repeated measurement of ejection fraction and for assessing the response to therapeutic interventions in critically ill patients.
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It is clear that amino acid-based nutritional support beneficially affects nitrogen balance. Less clear is the optimal composition of amino acids for nutritional support of the catabolic patient. ⋯ We discuss the concept of conditionally indispensable amino acids and review the requirements for histidine, serine, arginine, taurine, cysteine, tyrosine, and glutamine. The use of dipeptides for parenteral support of critically ill patients is reviewed and proposed changes in amino acid content for the catabolic patient are advanced.
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Comparative Study
Care of the critically ill patient: the impact of stress on the use of touch in intensive therapy units.
The literature suggests that stress is a major factor for nurses personally 'disengaging' from patients who are critically ill. This research aimed to investigate if nurses in a general intensive therapy unit (ITU) disengage from their patients by using touches that are mainly task orientated, rather than caring/social touches. This study sought to establish whether there was a relationship between categories of touch deployed by nurses and the individual characteristics of the nurses. ⋯ However, there was a significant relationship between caring/social touch and a nurse's length of service (rs = -0.54, P < 0.01). The interview data discovered that the stressors were related to the organizational pressures of the environment in which care was delivered, rather than the involvement of caring for critically ill patients. This apparent contradiction of the literature contributes a further dimension in considering the impact of management changes and organizational structures upon nurses' stress, which has further implications for the delivery of care in ITUs.
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Dietary manipulation may influence outcome after infection and injury by altering production of inflammatory mediators and disease activity. Restricted nutrient intake may have beneficial effects on life-span, development of degenerative disease, autoimmune processes, renal injury, susceptibility to infection, and survival rate after infection. ⋯ The optimal calorie/protein intake during different phases of critical illness remains to be established. However, a short period of restricted intake may be beneficial.