Articles: intensive-care-units.
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Case Reports Comparative Study
Intentions to select a given level of care when confronted with an ethical issue: the impact of a living will.
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Pharm Pract Manag Q · Apr 1999
Development and implementation of guidelines for management of sedation and agitation in critically ill patients.
The article describes the development, implementation, and success of guidelines for pharmacological management of sedation and agitation in critically ill patients in a community hospital. Guidelines were developed with careful review of published literature and in cooperation with thought leaders in the institution. ⋯ A prospective pharmacist intervention program was initiated for further enforcement of the guidelines. Implementation of these guidelines has resulted in a significant reduction in the cost of sedation and agitation (annual cost savings, > $40,000 per year).
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Review
Sedation and analgesia in paediatric intensive care units: a guide to drug selection and use.
The indications for sedation in the paediatric intensive care unit (PICU) patient are varied ranging from short term use for various procedures to prolonged administration to provide comfort during mechanical ventilation. When faced with the decision to institute sedation, the healthcare provider must make three decisions: the agent to be used, the route of delivery, and the mode of administration (intermittent versus continuous). ⋯ This review describes the various agents for sedation and discusses their advantages and disadvantages as they pertain to the PICU. Consequences of and treatment strategies for long term problems with prolonged sedation including tolerance, physical dependency, and withdrawal are reviewed.
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Intensive care medicine · Apr 1999
Multicenter StudyApplication of SOFA score to trauma patients. Sequential Organ Failure Assessment.
To assess the ability of the SOFA score (Sequential Organ Failure Assessment) to describe the evolution of organ dysfunction/failure in trauma patients over time in intensive care units (ICU). ⋯ The SOFA score can reliably describe organ dysfunction/ failure in trauma patients. Regular and repeated scoring may be helpful for identifying categories of patients at major risk of prolonged ICU stay or death.
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Am. J. Respir. Crit. Care Med. · Apr 1999
Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit.
The etiology of sleep disruption in patients in intensive care units (ICUs) is poorly understood, but is thought to be related to environmental stimuli, especially noise. We sampled 203 patients (121 males and 82 females) from different ICUs (cardiac [CCU], cardiac stepdown [CICU], medical [MICU], and surgical [SICU]) by questionnaire on the day of their discharge from the unit, to determine the perceived effect of environmental stimuli on sleep disturbances in the ICU. Perceived ICU sleep quality was significantly poorer than baseline sleep at home (p = 0.0001). ⋯ Disruption from human interventions and diagnostic testing were perceived to be as disruptive to sleep as was environmental noise. In general, patients in the MICU appeared to be more susceptible to sleep disruptions from environmental factors than patients in the other ICUs. Our data show that: (1) poor sleep quality and daytime sleepiness are problems common to all types of ICUs, and affect a broad spectrum of patients; and (2) the environmental etiologies of sleep disruption in the ICU are multifactorial.