Articles: critical-illness.
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Randomized Controlled Trial Clinical Trial
Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study.
To determine the efficacy and safety of cimetidine and sucralfate prophylaxis for stress-related gastrointestinal hemorrhage in patients admitted to a medical intensive care unit. ⋯ The observed effects of cimetidine and sucralfate on the incidence and severity of hemorrhage from stress-related gastritis were not significant when compared with no treatment. Routine prophylaxis with these agents for patients entering the medical intensive care unit does not seem warranted.
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To review recent revisions of systems for estimating the probability of hospital mortality of adult intensive care unit (ICU) patients. Emphasis on comparison of components of systems and potential uses. ⋯ All models were based on rigorous research and reported performance is good. All can be used to assist in assessing prognosis, to compare ICU performance, and to stratify patients for clinical trials. Direct comparison on a common cohort is needed.
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Shock index (SI) (heart rate/systolic blood pressure; normal range, 0.5 to 0.7) and conventional vital signs were compared to identify acute critical illness in the emergency department. ⋯ With apparently stable vital signs, an abnormal elevation of the SI to more than 0.9 was associated with an illness that was treated immediately, admission to the hospital, and intensive therapy on admission. The SI may be useful to evaluate acute critical illness in the ED.
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Anaesth Intensive Care · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of vecuronium administered by the Springfusor infusion device to vecuronium by intermittent bolus injection in critically ill adult patients.
To evaluate the Springfusor infusion device for clinical use in an Intensive Care Unit and to compare the technique of intermittent bolus and constant infusion of muscle relaxants, we undertook a prospective double-blind randomized placebo-controlled study. Twenty critically ill ventilated patients requiring muscle paralysis were investigated. ⋯ The device is robust, easy to use and reduces nursing workload. This may translate into cost-saving improvement in patient care if the Springfusor is used to provide muscle relaxation, sedation and analgesia.
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Critical care clinics · Oct 1994
ReviewPharmacology of intravenous sedatives and opioids in critically ill patients.
Many agents are available for sedation of agitated, delirious patients. In general, they should be administered intravenously to achieve a painless, more rapid, and more reliable onset of action. Proper selection of an agent requires understanding the basic principles discussed in this article, including the T-1/2 alpha and T-1/2 beta and the side-effect profile associated with each class of drugs, as well as for each agent. ⋯ Once sedation has been achieved, control usually can be maintained with continuous intravenous infusions of BNZs, perhaps in combination with a continuous infusion of an opioid or intermittent administration of a neuroleptic agent. With goal-oriented titration of the pharmacologic therapy, patients can be maintained safely in a sedate, calm state; intermittent periods of agitation, alternating with periods of severely depressed level of consciousness, can be avoided. Finally, when pharmacologic suppression of agitation and delirium is needed, the patient must be evaluated fully to determine the underlying cause of the confusional state.