Articles: critical-illness.
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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.
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American heart journal · May 1994
Transesophageal echocardiography in critically ill patients: feasibility, safety, and impact on management.
Transesophageal echocardiography (TEE) is being used with increasing frequency in critically ill patients in whom transthoracic echocardiography (TTE) is often unsatisfactory in providing much needed information. We reviewed the indications, feasibility, and clinical impact of TEE in the intensive care setting at our institution. TEE was performed in 77 critically ill patients (age range 19 to 83 years) in whom TTE was inadequate or inconclusive. ⋯ In these patients (n = 37), the TEE findings led to a change in medical management in 19% and to surgical intervention in 29%. While TTE remains the first line of diagnostic ultrasound and Doppler in critically ill patients, it can be technically difficult or inconclusive. In this setting, TEE provides a safe and powerful diagnostic tool that can help guide patient management.
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Comparative Study
[Failure of prediction of results with APACHE II. Analysis of prediction errors of mortality in critical patients].
The evaluation of the prognosis of critically ill patients by the APACHE II method is common in intensive care units (ICU). The aim of the present was to analyze the possible factors associated to errors in prediction. ⋯ The factors analyzed did not demonstrate that they may influence or be associated with errors in prediction of the prognosis of patients admitted to an intensive care unit, with these errors probably being due to errors in the system used.