Heart & lung : the journal of critical care
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The delirium that is commonly associated with admission to an intensive care setting (intensive care unit [ICU] psychosis) may be terrifying to the patient, but may go undetected by the nurse. Our current understanding of this delirium is discussed according to incidence, defining characteristics, and etiologic or contributing factors such as predisposing patient factors, pharmacologic agents, and environmental factors. ⋯ These episodes of delirium are examined with reference to sensory-perceptual, perceptual or sensory alterations. We discuss nursing interventions that help to prevent or lessen the impact of delirium before an ICU admission, during the ICU course, and after discharge from the ICU.
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By consensus, the most clinically important consequence of near drowning is hypoxemia. Whether it is due to physiologic shunting induced by diffuse alveolar flooding from saltwater aspiration or to diffuse atelectasis induced by surfactant inactivation from freshwater aspiration, both physiologic disturbances can be reversed with the institution of positive-pressure breathing in the form of PEEP or CPAP, which should be the mainstay of pulmonary management of respiratory insufficiency in these patients. The use of prophylactic antibiotics or corticosteroids as an adjunct in the management of pulmonary insufficiency resulting from near drowning is not warranted, may be detrimental, and remains controversial. ⋯ A significant subset of comatose near-drowning victims survive with eventually normal neurologic recovery when routine aggressive supportive intensive care is administered. Uncontrolled studies reporting improved outcomes with the institution of complex cerebral salvage techniques, such as induction of hypothermia, intracerebral pressure monitoring, induction of barbiturate coma, and the use of corticosteroids and osmotic diuretics, remain controversial. It is now clear that neither induced hypothermia nor barbiturate coma improves survival or neurologic outcome in these patients and may be detrimental.(ABSTRACT TRUNCATED AT 250 WORDS)
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The thermodilution method of measuring cardiac output has a firm scientific basis and provides data to assist clinicians in assessing the hemodynamic function of patients and evaluating therapeutic interventions. Most of the research that validated this method of measurement was conducted from 1954 to 1979. Research in the 1980s focuses primarily on refining measurement techniques evaluating protocols that will simplify measurements in the clinical setting, and testing new devices that have the potential for affecting the accuracy of measurements. Although discrepancies between theory and application took years to resolve resulting in initial resistance to this method, thermodilution cardiac output measurement is now well accepted by researchers and clinicians as safe, simple, and accurate.