Articles: critical-illness.
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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.
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This descriptive study looked at how nurses positioned the critically ill person in the Intensive Care Unit. Its objective was to identify what positions were utilised, and whether severity of illness influenced this choice. ⋯ As the severity of illness increased, more horizontal positions were utilised. These findings and review of the literature highlights a need for further research into specific aspects of the use of position during critical illness.
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Sepsis, shock, multiple trauma, and burns are often associated with altered metabolism characterized by severe catabolism, wasting of the lean body mass, immune dysfunction, and compromised wound healing. Nutrition support is one of the mainstays in the management of these critically ill patients and is aimed at minimizing these complications. The purpose of this article is to compare stress hypermetabolism and starvation metabolism, to review current recommendations for the provision of energy and substrate to the critically ill patient, and to review pertinent literature regarding enteral vs parenteral nutrition. Finally, this article will provide a brief overview of new and future therapies with emphasis on specific substrates and growth factors and the potential for their use in the critically ill patient.
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To determine if the phlebostatic axis (PA) can be used to obtain reproducible central venous pressures (CVP) in laterally positioned critically ill patients. ⋯ Of the three leveling procedures, the supine PA yielded the most reproducible CVP measures. However, further studies are required before the supine PA can be recommended as a valid and reliable transducer position for CVP measurement in laterally positioned patients.