Critical care clinics
-
Critical care clinics · Jul 2006
The World Federation: enhancing global critical care practice and performance.
The World Federation of Societies of Intensive and Critical Care Medicine is an international organization composed of 42 members of national societies of intensive and critical care medicine representing approximately 38,000 physicians and allied health professionals. To appreciate the importance of international collaboration in various specialties, it is imperative to recognize not only the similarities within health systems, but also to recognize the international focus of disease.
-
Critical care clinics · Jul 2006
Consensus forum: worldwide guidelines on the critical care nursing workforce and education standards.
This article explores the key themes, evidence, and arguments that inform the current position statements. It is acknowledged that future research, evidence, and practice experience may create the need to review and change these guidelines. Reform and refinement of the guidelines are inevitable; however, the current guidelines represent the best attempt yet to reach international consensus on what are appropriate standards to guide critical care nursing education and workforce requirements.
-
Critically ill patients generally are older, frequently have organ failure, and commonly receive multiple medications, all of which make them susceptible to adverse effects of drugs. Drug interactions are a common adverse effect, and many are predictable based on understanding the mechanisms that underlie drug interactions. This article identifies commonly used medications in critically ill patients and the associated drug interactions that may occur with emphasis on the cytochrome P450 enzyme system.
-
Critical care clinics · Apr 2006
ReviewSedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill.
Sedatives and analgesics are routinely used in critically ill patients, although they have the potential for side effects, such as delirium and sleep architecture disruption. Although it should be emphasized that these medications are extremely important in providing patient comfort, health care professionals must also strive to achieve the right balance of sedative and analgesic administration through greater focus on reducing unnecessary or overzealous use. Ongoing clinical trials should help us to understand whether altering the delivery strategy, via daily sedation interruption, or protocolized target-based sedation or changing sedation paradigms to target different central nervous system receptors can affect cognitive outcomes and sleep preservation in our critically ill patients.
-
Physiologic alterations in critically ill patients can significantly affect the pharmacokinetics of drugs used in the critically ill patient population. Understanding these pharmacokinetic changes is essential relative to optimizing drug therapy. This article outlines the major differences seen in the absorption, distribution, metabolism, and excretion of drugs in critically ill patients. Important strategies for drug therapy dosing and monitoring in these patients are also addressed.