Aust Crit Care
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Observational Study
Mechanism of paracetamol-induced hypotension in critically ill patients: a prospective observational cross-over study.
To elucidate the mechanism of hypotension following intravenous administration of paracetamol (acetaminophen) to patients on the Intensive Care Unit. ⋯ Hypotension with intravenous paracetamol in critically ill patients is caused by a reduction of both cardiac output and systemic vascular resistance. We did not demonstrate any relation between haemodynamic changes and antipyretic action of paracetamol. A possibility that cardiac output is reduced with paracetamol might be clinically important.
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Sedation of intensive care patients is necessary for comfort and to implement appropriate treatment. The trend of sedation has gone from deep to light sedation. The topic is of interest to intensive care nursing because patients are generally more awake, which requires a different clinical approach than caring for deeply sedated patients. ⋯ The results reinforce the importance of communication in nursing care. It is difficult however to create an inter-personal relationship, encourage patient involvement, and maintain communication with deeply sedated patients. When patients are lightly sedated, the nurses are able to communicate, establish a relationship and provide individualised care. This is a challenge requiring expertise and patience from the nurses. Accomplishing this increases the nurses satisfaction with their care. The positive outcome for the patients is that their experience of their stay in the ICU might become less traumatic.
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Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. ⋯ This study will provide new evidence to improve care during critical illness and reduce adverse outcomes during recovery with the potential to decrease unnecessary suffering, promote comfort and improve long-term recovery.
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Review Meta Analysis
Intravenous magnesium therapy in adult patients with an aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis.
The value of magnesium for the prevention of cerebral arterial vasospasm in patients with aneurysmal subarachnoid haemorrhage (SAH) is debatable. We performed a systematic review to collate the available evidence to evaluate the effects of intravenous magnesium for the prevention of cerebral arterial vasospasm. ⋯ We identified a benefit in the role of magnesium to reduce the incidence of cerebral vasospasm in patients with an aneurysmal SAH. However no benefit was found regarding improved favourable functional outcome or a reduction of mortality.
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Considering that the incidence of fever may reach up to 75% among critically ill adults, healthcare professionals employed in the Intensive Care Unit (ICU) are called to evaluate and manage patient temperature elevation on a daily basis. This literature review synthesizes the evidence about the effects of fever and antipyretic treatment in ICU patients. Although the febrile response acts protectively against infections, noxious effects are possible for patients with cerebral damage, neuropsychiatric disorders or limited cardiorespiratory reserve. ⋯ However, fever suppression and return to normothermia improved outcomes of septic shock patients. Antipyretic treatment should begin with drug administration and proceed with external cooling in case of refractory fever, but adverse effects of both antipyretic methods should always be considered. This article concludes by providing implications for antipyretic treatment of critically ill adults and suggesting areas for future research.