Current opinion in anaesthesiology
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Palliative sedation, the conscious induction of sleep in patients with a very short life expectancy who suffer intractable physical and existential distress, may offer the patient and his or her relatives a more peaceful dying. This technique is still subject to several ethical and medical controversies justifying a review of the recent literature on this subject. ⋯ Palliative sedation may be considered for terminally ill patients who suffer intractable symptoms. Ideally it should be included in the patient's trajectory that has been described and discussed earlier when the disease was judged to be incurable. The main goal is to offer comfort.
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Curr Opin Anaesthesiol · Apr 2007
Review Comparative StudyWhy is there such a difference in outcome between Australian intensive care units and others?
The aim of this article is to assess the data on clinical outcomes for critically ill patients admitted to Australian and New Zealand intensive care units in comparison to information available for similar patients in other counties ⋯ Although comparisons in outcome between Australia and New Zealand intensive care units and other units worldwide may not have sufficient scientific rigour to truly reflect better national outcomes, many features of Australian and New Zealand units are unique and worthy of consideration by other national systems as they consider their strategic national goals for the next decade.
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To review literature germane to the care of critically ill obese patients with emphasis upon the pathophysiology of obesity and its impact on clinical management. ⋯ Obesity has pathophysiologic effects upon all major organ systems. A thorough knowledge of these effects and specific intensive care unit-related issues are necessary for clinicians to anticipate common complications and provide timely and effective treatment for the obese intensive care unit patient.
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Curr Opin Anaesthesiol · Apr 2007
ReviewDelirium, cognitive dysfunction and posttraumatic stress disorder.
In the critically ill patient, disease and the therapies we use impact on brain function. Simple tools are now available to recognise such problems. This review highlights neuropsychiatric and cognitive observations that have direct relevance to patient care and outcome. ⋯ Health professionals working with the critically ill must routinely include the assessment of brain cognitive function. While some of the consequences may be unavoidable, we need to reassess our sedation and care practices to ensure we are not confounding the problem. Practical options to improve outcome are being developed and emphasise that the recovery from critical illness is psychological as well as physical.
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To review the recent advances in providing analgesia and sedation to intensive care unit patients that can improve outcomes, and reduce resource utilization and adverse events. ⋯ Utilizing and incorporating these new advances can improve outcomes and result in a more comfortable patient.