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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Critical care medicine · Mar 1994
Continuous infusion of haloperidol controls agitation in critically ill patients.
To evaluate the safety and efficacy of continuous infusion of haloperidol in treating agitated critically ill adult patients. ⋯ Continuous infusion of haloperidol effectively controls severe agitation in critically ill patients, reduces requirements for bolus administration of sedatives and nursing time lost to that task, and may facilitate ventilator weaning. Parenteral administration of haloperidol was associated with few complications in > 1,340 patient-hours of continuous administration.
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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.