Articles: intensive-care-units.
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In a prospective study, the intensity of extrapyramidal symptoms (EPS) was rated in two groups of delirious, medically ill patients. Fourteen patients received intravenous (IV) haloperidol and benzodiazepines for control of severe agitation and four received IV haloperidol alone. Patients were rated daily by a standardized scale for EPS by raters blind to the dose of haloperidol and benzodiazepines. ⋯ In the haloperidol and benzodiazepine group there were only one case of very mild parkinsonian-like EPS and no cases of akathisia or dystonia. No adverse respiratory or cardiac reactions were seen in any patients. The literature on the use of IV haloperidol alone and in combination with benzodiazepines is briefly reviewed and possible explanations of the lower intensity of EPS with IV haloperidol in combination with benzodiazepines are discussed.
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Of 1136 patients admitted consecutively to two medical-surgical intensive care units, 100 were found to have multiorgan failure, defined as failure of more than two organ systems. The average duration of stay in the intensive care units was 13.4 days. The overall death rate was 78% compared with 12.8% for patients without multiorgan failure. ⋯ Surgery during the course of multiorgan failure had neither an adverse nor beneficial effect on outcome. The mean number of organ systems failing was 4.36 for survivors and 5.03 for nonsurvivors. The most common systems to fail were central nervous, cardiovascular and respiratory.
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The delirium that is commonly associated with admission to an intensive care setting (intensive care unit [ICU] psychosis) may be terrifying to the patient, but may go undetected by the nurse. Our current understanding of this delirium is discussed according to incidence, defining characteristics, and etiologic or contributing factors such as predisposing patient factors, pharmacologic agents, and environmental factors. ⋯ These episodes of delirium are examined with reference to sensory-perceptual, perceptual or sensory alterations. We discuss nursing interventions that help to prevent or lessen the impact of delirium before an ICU admission, during the ICU course, and after discharge from the ICU.