Crit Care Resusc
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To report Palmerston North Hospital's (PNH) recent experiences with paediatric admissions to the general Intensive Care Unit (ICU), and to identify any aspects relevant to regionalisation of paediatric intensive care. ⋯ If the PNH experience reflects that of other similar institutions, then non-tertiary ICUs admit small numbers of critically ill paediatric patients who tend to be of low to moderate severity, but who cover the full spectrum of severity. Most cases can be well managed locally, but appropriate referral and transfer is an important component in the delivery of a rational and integrated paediatric intensive care service.
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To describe a new approach to circulating volume control in critically ill patients. ⋯ Use of a P(msa) volume signal enables prolonged stable closed loop volume servocontrol. In global heart dysfunction the dimensionless variable (P(msa )- RAP)/P(msa )may be used to guide inotropic therapy.
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To review the role of drugs with potential benefit to renal function in critically ill patients. ⋯ The common factor in renal dysfunction and acute renal failure is tubular ischaemia. Prevention of this final common pathway is the chief goal of renal protection in critically ill patients. Despite the plethora of potentially beneficial drugs, volume loading and defence of renal perfusion pressure (and renal blood flow) with pressor agents appear to be the only reliable means of renal protection.
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To review the metabolism and function of potassium and causes and management of hypokalaemia. ⋯ Hypokalaemia can be asymptomatic or it may cause cardiovascular, neurological or skeletal muscle dysfunction. If intravenous potassium therapy is required, then correction with potassium chloride, acetate, or phosphate salts are usually guided by the presence of a metabolic acidosis, alkalosis or hypophosphataemia.
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To review the current status of echocardiography in critically ill patients with special reference to the advantages and disadvantages of the transthoracic and transoesophageal approaches. ⋯ Echocardiography is a rapidly developing technology. Cardiac structures can be imaged in 'real time'. Image quality continues to improve. The use of transoesophageal probe positioning has also widened the potential of this bedside technique in critically ill patients.