Articles: critical-illness.
-
This paper highlights hazards involved in moving critically ill patients between locations, discusses minimalisation of risks involved and the advantages of specialist teams. ⋯ Critically ill patients are moved within the hospital because of the need for surgical procedures or to have fixed facilities investigations performed. Interhospital movement of patients is necessary for specialised care available elsewhere. This has increased with centralisation of specialist services. This paper adopts a practical approach to the transfer process. It establishes the goals of conducting a safe transfer, highlights the deleterious effects of moving an ill patient, the risks and pitfalls of a transfer, and how to minimise them. Attention is drawn to the need for proper resuscitation and stabilisation of a patient before transport. The quality and outcome of the transfer depend on the experience of the transferring team and on adequate monitoring facilities. The benefits of a specialist transfer team is suggested.
-
Over the last decade there has been considerable interest in the use of specific nutrients to alter the metabolic response to injury and infection, to improve immune function, and to prevent or reverse the severe catabolism and wasting of the lean body mass that accompanies critical illness. In this review, representative animal studies and, when available, human studies examining the potential benefits of these individual nutrients are summarized. The overview of basic investigations is by no means all-inclusive, and the emphasis of this manuscript is a review of the currently available clinical trials examining the potential benefits of combinations of these individual immunity-enhancing nutrients in human patients.
-
Respir Care Clin N Am · Mar 1997
ReviewTo everything turn, turn, turn.... An overview of continuous lateral rotational therapy.
Continuous lateral rotational therapy can be a significant adjunct in the care of the critically ill patient. CLRT has a great impact on both patient outcomes as well as cost containment in the care of the critically ill. These systems should be used with clear guidelines to determine when CLRT is indicated, its therapeutic benefit, and when to discontinue the therapy. Much research is needed to validate efficacy of particular systems, cost-effectiveness, and necessary frequency and degree of rotation to attain optimal clinical benefits.
-
Since the circulatory and pulmonary systems are both driven by pressure and share space in the thorax, it is inevitable that they interact. These mechanical interactions, whilst relatively few in number, are protean in their manifestations. The circulatory system of the critically ill is often particularly susceptible to interference from respiration. ⋯ This review will examine the basic physiological mechanisms through which the pulmonary and circulatory systems interact. These mechanisms will then be applied to a variety of weaning, positive end-expiratory pressure (PEEP), and cardiopulmonary resuscitation techniques. It is hoped that this will provide the tools to understand clinical observations which would otherwise appear inexplicable.