Journal of critical care
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Journal of critical care · Dec 2009
ReviewState of the art: sedation concepts with volatile anesthetics in critically Ill patients.
The use of volatile anesthetics in the intensive care unit (ICU) has only been possible at great cost with the use of commercially available anesthesia systems. A new anesthetic-conserving device (AnaConDa) now facilitates, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients as part of prolonged sedation, using ICU ventilators. The volatile anesthetic is hereby applied continually via a syringe pump into a miniature vaporizer, which is integrated into the ventilator circuit in place of the usual respiratory filter. ⋯ Aside from the possibility of using a central anesthetic gas scavenging system, the use of special passive residual gas filters, which can be connected to the expiratory outlet of the respirator machine, appears above all to be practical. The use of volatile anesthetics on the ICU could adopt a permanent position in various intensive care analgosedation concepts in future. It may be possible thereby to optimize the treatment process both in medical and economical terms.
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Journal of critical care · Dec 2009
Multicenter StudyMore men than women are admitted to 9 intensive care units in British Columbia.
The aim of this study is to determine if more males than females are admitted to adult intensive care units (ICUs). ⋯ More men than women are admitted to ICUs; this difference is especially prominent in elderly patients.
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Delirium is common but underdiagnosed in critical care units, which results in increased morbidity and mortality. This study aimed to evaluate the reliability and validity of diagnosing delirium with the Memorial Delirium Assessment Scale (MDAS) in India. ⋯ Our findings suggest that training junior residents to use a brief screening instrument to diagnose delirium is a reliable and valid option in resource-poor critical care settings.
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Journal of critical care · Dec 2009
Safety of drotrecogin alfa (activated) in severe sepsis: data from adult clinical trials and observational studies.
Drotrecogin alfa (activated) (DrotAA), or recombinant human activated protein C, represents the only Food and Drug Administration-approved therapy for mortality reduction in adult patients with severe sepsis. Drotrecogin alfa (activated) has properties that address microvascular injury in severe sepsis through its direct effects on endothelial cells and leukocytes while also having antithrombotic and indirect profibrinolytic properties. ⋯ Bleeding is more common in DrotAA-treated patients; therefore, a careful assessment of bleeding risk and an understanding of the safety profile is required. This summary provides a detailed review of safety data and outcomes of patients treated with DrotAA in recent clinical studies enrolling more than 7000 adult patients.
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Journal of critical care · Dec 2009
Delirium recognition and sedation practices in critically ill patients: a survey on the attitudes of 1015 Brazilian critical care physicians.
The aim of the study was to characterize the practices of Brazilian ICU physicians toward sedation and delirium. ⋯ Despite the recent advances in knowledge of sedation and delirium, most of them are still not translated into clinical practice. Significant variation in practice is observed among ICU physicians and represents a potential target for future research and educational interventions.