Clinical intensive care : international journal of critical & coronary care medicine
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Clin Intensive Care · Jan 1994
Comparative StudyQuality of life at three months following admission to intensive and coronary care units.
Measurement of quality of life three months following critical illness, to assess impact on health expectations. ⋯ ICU patient quality of life three months after admission compares favourably with a corresponding group of CCU patients, particularly in areas of sleep and social isolation. CCU patients' general functional status deteriorated significantly compared to their pre-admission status. Critical illness is a costly area of medicine, but the results suggest that outcomes are beneficial in terms of quality of life for those surviving acute illness.
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The transition from mechanical ventilation to spontaneous breathing in the intensive care unit is a two-stage process: weaning and extubation. Certain parameters require consideration before the commencement of weaning, namely respiratory function (both pulmonary gas exchange and respiratory muscle strength), cardiovascular status, stability of clinical condition, low metabolic demands, psychological factors and, possibly, patient collaboration. Appropriate sedation is crucial for successful weaning to keep the patient rested and to maintain the oxygen consumption and carbon dioxide production low. ⋯ This transition may be considered to comprise two separate stages, namely weaning and extubation. Weaning consists of preparation for spontaneous breathing supported and monitored by a mechanical ventilator and attendant monitoring of all the important vital parameters, while extubation marks the final switch to unsupported spontaneous breathing, which may be quite a big step for the patient. Important weaning parameters.
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Clin Intensive Care · Jan 1994
ReviewA multi-disciplinary approach to families of brain dead children.
To relate our multi-disciplinary approach to families of brain dead children. ⋯ Our multi-disciplinary approach may assist clinicians and other health care providers in successfully dealing with families of brain dead children.
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Clin Intensive Care · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialCost of ICU sedation: comparison of empirical and controlled sedation methods.
A randomised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients. Patients (n = 40) entering the ICU were enrolled provided they satisfied the strict entry criteria. During 90 hours of midazolam sedation, patients received randomly allocated 10-hour periods of controlled or empirical sedation. ⋯ In a separate study on 352 patients, a cost-benefit analysis of controlled sedation with midazolam or propofol infusion or bolus injections of morphine plus diazepam showed that the quality of sedation achieved with propofol was superior to the other two regimens and that, with morphine plus diazepam, the quality of sedation was unacceptably poor. Although the direct purchase price of propofol was higher than that of other agents, the total cost of sedation with propofol was lower than that for midazolam for short-term intensive care (less than 24 hours) and comparable to midazolam for longer-term use. However, indirect benefits of sedation with propofol include a much shorter ICU stay with the attendant reduced nursing costs and greater throughout the patients, and this more than compensates for the higher purchase price of the agent.
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Clin Intensive Care · Jan 1994
ReviewNew horizons in ICU sedation: exploring non-sedative effects of ICU sedation.
Sedative drugs are widely used in intensive care, primarily in ventilated patients. The common actions and side-effects of these agents are widely recognised. However, recent evidence suggests that opiates and other sedative agents that are used in this situation also have important, but not widely appreciated, effects on metabolism, physiological signalling and disease mechanisms. ⋯ First, they provide explanations for some phenomena observed during their use. Second, some of the undesirable side-effects may be avoided by judicious use of drugs in certain clinical situations. Finally, there is the prospect that we may be able to harness some actions for novel therapeutic purposes.