Articles: intensive-care-units.
-
Critical care medicine · May 2008
Randomized Controlled TrialA randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit.
To compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients. ⋯ This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management. Qualified high-intensity nurse staffing and routine Australian intensive care unit nursing responsibility for many aspects of ventilatory practice may explain the contrast between these findings and some recent North American studies.
-
Critical care medicine · Apr 2008
Randomized Controlled Trial Multicenter StudyUsing the medical record to evaluate the quality of end-of-life care in the intensive care unit.
We investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU). ⋯ We identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Family member satisfaction with end-of-life decision making in the ICU.
Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. ⋯ Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
-
Critical care medicine · Mar 2008
Randomized Controlled Trial Comparative StudyShort- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam--a pilot study.
To compare memories from the intensive care unit (ICU) and short- and long-term psychological morbidity in patients after sedation with intravenous midazolam or inhaled isoflurane. ⋯ Sedation of ICU patients with isoflurane may result in fewer delusional memories or hallucinations from the ICU compared with more commonly used intravenous sedation. Memories of negative feelings from the ICU were associated with symptoms of depression or anxiety or symptoms indicating posttraumatic stress disorder. Further study of memory and cognitive/psychological recovery after prolonged isoflurane sedation beyond 96 hrs is warranted.
-
Comment Randomized Controlled Trial Multicenter Study
Sedation in the intensive-care unit: good and bad?