Articles: critical-illness.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol vs midazolam in short-, medium-, and long-term sedation of critically ill patients. A cost-benefit analysis.
The purpose of this study was to evaluate and compare the clinical effects, safety, and economic cost of propofol and midazolam in the sedation of patients undergoing mechanical ventilation in the ICU. Eighty-eight critically ill patients were studied and randomly allocated to receive short-term (less than 24 h), medium-term (24 h to 7 days), and prolonged (more than 7 days) continuous sedation with propofol (n = 46) or midazolam (n = 42). Mean doses required were 2.36 mg/kg/h for propofol and 0.17 mg/kg/h for midazolam. ⋯ Recovery of total consciousness was predictable according to sedation time in propofol-treated subgroups (r = 0.98, 0.88, and 0.92, respectively), while this correlation was not observed in the midazolam-treated group. In the subgroup with sedation of less than 24 h, propofol provided a cost savings of approximately 2,000 pesetas (pts) per patient, due to shorter stays in the ICU. We conclude that propofol is a sedative agent with the same safety, higher clinical effectiveness, and a better cost-benefit ratio than midazolam in the continuous sedation of critically ill patients.
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AACN Clin Issues Crit Care Nurs · Feb 1993
Using continuous SVO2 to assess oxygen supply/demand balance in the critically ill patient.
To ensure that tissues are well oxygenated, oxygen supply and demand are now targets of therapy for the critically ill patient. This chapter reviews the physiologic determinants of oxygen supply, how it is threatened by respiratory or cardiac dysfunction or by hemorrhaged or anemic states, and how it can be assessed in individual patients. ⋯ Failure of tissues to consume enough oxygen is explained in patients with critically low delivery or with the maldistributed blood flow state seen in sepsis. The monitoring of mixed venous oxygen saturation is examined as a method of tracking the threats to supply/demand balance and of guiding treatment that can support the adequate oxygenation of tissue.
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Anaesth Intensive Care · Feb 1993
Randomized Controlled Trial Clinical TrialEnteral feeding, gastric colonisation and diarrhoea in the critically ill patient: is there a relationship?
In this prospective study we aimed to determine whether there is any relationship between enteral feeding, gastric colonisation and diarrhoea in the critically ill patient. Sixty-two critically ill patients from an intensive care unit of a major teaching hospital, who satisfied the usual criteria for enteral feeding, were randomised to receive enteral feeding or not for three days followed by a second randomisation to enterally feed or not for three days. ⋯ Gastric colonisation was unrelated to feeding practice and to the development of diarrhoea. We conclude that in the critically ill patient, enteral feeding does not cause or promote diarrhoea.
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This paper reviews presently available techniques for monitoring the adequacy of tissue oxygenation, emphasizing the practical and theoretical problems that exist with presently used measurements. ⋯ In attempting to develop tools to assess adequate tissue oxygenation, emphasis should be placed on the monitoring of individual tissues that are felt to be highly susceptible to reduced oxygen delivery and key to overall survival. Preliminary data involving measurements of the interstitial pH of the gastrointestinal tract suggest that this measurement may be one approach to pursue.
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To identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay. ⋯ Neurologic complications are associated with increased mortality rates and longer medical ICU and hospital lengths of stay. These conditions are probably underrecognized at present. ICUs have the potential to serve as environments for neurologic teaching and research.