Articles: critical-illness.
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Multicenter Study
Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group.
The efficacy of prophylaxis against stress ulcers in preventing gastrointestinal bleeding in critically ill patients has led to its widespread use. The side effects and cost of prophylaxis, however, necessitate targeting preventive therapy to those patients most likely to benefit. ⋯ Few critically ill patients have clinically important gastrointestinal bleeding, and therefore prophylaxis against stress ulcers can be safely withheld from critically ill patients unless they have coagulopathy or require mechanical ventilation.
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Review
Persistent paralysis in critically ill patients after the use of neuromuscular blocking agents.
Neuromuscular blocking agents (NMBAs), an important part of the pharmacologic armamentarium of the intensivist, have a long and admirable history of safety when used in the operating room for periods of time (almost always < 12 hrs). Since 1985, dozens of medical journals have reported a multitude of studies on persistent paralysis when these same agents are exported from the operating room to the ICU. Most of these reports are case presentations of patients who failed to move for days to weeks after discontinuation of NMBAs. ⋯ This article sorts through the issues surrounding persistent paralysis, and defines it as a short-term and a long-term problem. The short-term problem seems to have a pharmacologic explanation that is not difficult to correct. The long-term problem is much more complex and may have a toxic explanation that may also be more difficult to manage.
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Elderly people in the United States often receive treatment through an enormous array of medical technology when they become critically ill. Some, or all, such interventions may be unwanted, and patients have the right to be informed about what prospects lie ahead. CPR, with survival rates of 2% to 20%, rarely has the effect for which it was intended, as studies over the last two decades have repeatedly demonstrated. ⋯ This is unfortunate, because both surrogates and physicians are poor judges of patients' resuscitation preferences. Advance directives, especially when coupled with effective physician-patient communication, will aid elderly persons in making decisions about life support. We encourage all physicians who care for the elderly to avert many of tomorrow's ethical dilemmas by communicating with their healthy patients today.
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To describe the typical ranges for central venous oxygen saturation and PO2 in a group of critically ill neonates and the relationship of these measurements to measurements of arterial oxygenation and indicators of oxygen supply and demand. ⋯ We conclude that measurement of central venous oxygenation in ill neonates may reflect more accurately the oxygen supply and demand status of the neonate than measurement of arterial oxygenation alone.
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Critical care medicine · Feb 1994
Variability of cardiac output over time in medical intensive care unit patients.
To determine the amount of spontaneous variability of cardiac output over time in critically ill patients, and to determine the effect of mechanical ventilation on cardiac output variability over time. ⋯ The spontaneous variability of cardiac output should be considered when interpreting two cardiac output determinations made at separate times. Due to spontaneous variability alone, a patient with a baseline cardiac output of 10.0 L/min would be expected (95% confidence interval) to have a cardiac output range of 9.2 to 10.8 L/min if covariables were stable, and a range of at least 8.8 to 11.2 L/min if covariables were unstable. Patients who were mechanically ventilated displayed less variability than patients who were breathing spontaneously.