Articles: critical-illness.
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The objective of this study was to identify the underlying causes of respiratory-related critical events associated with intravenous patient-controlled analgesia (i.v. PCA). ⋯ Following review of the critical events, it was determined that the design of the PCA device contributed to the misprogramming errors and the device was removed from service. Changes in the training of physicians and nurses were instituted to avoid recurrence of other errors identified. The incidence of serious respiratory-related critical events was 0.1%. i.v. PCA therapy has the risk of potentially serious complications and requires constant physician and nursing care with an active quality assurance program.
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Comparative Study
The use of analgesics and sedatives in critically ill patients: physicians' orders versus medications administered.
To examine the difference between the prescribed and actually administered dose of analgesic and sedative drugs in critically ill patients. ⋯ Physicians tended to write fairly nonspecific orders that were used by the nursing staff as very broad guidelines. A need exists to educate physicians as to what patients actually receive for sedation and analgesia and at the same time improve the dialogue between nurses and physicians as to what patients actually require.
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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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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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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.