Articles: critical-illness.
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The purpose of this article is to provide an overview of completed studies that consider visitors in critical care areas. Studies from coronary care, intensive care, pediatric PACUs, and adult PACUs are reviewed.
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Critical care clinics · Oct 1992
ReviewCentral venous catheterization in the critically ill patient.
Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.
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Critically ill patients are transported within and between hospitals on a regular basis; thus, transport of the critically ill is a component of most intensivists-practice. The motivation for these transports lies in obtaining diagnostic or therapeutic services not available at the bedside (intrahospital transport) or not available in the sending institution (interhospital transport). Deterioration in respiratory, cardiovascular, and other physiological systems is a potential complication of any patient transport. Using appropriate equipment and personnel and planning for each transport can minimize these complications and ensure optimal benefit to the patient.
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Physicians need to be maximally aggressive in their use of total enteral nutrition (TEN) in the critically ill patient, due to its lower cost, better physiology, and lower complication rate when compared to parenteral therapy. Various components in TEN such as glutamine, arginine, RNA nucleotides, omega-3 fish oils, and fiber, may have important roles in immunonutrition by maintaining gut integrity, stimulating the immune system, and preventing bacterial translocation from the gut. For each patient, the physician must choose the optimal enteral formula for that particular disease or organ failure state to maximize nutrient substrate assimilation and tolerance. Total parenteral nutrition (TPN) should be used only when a true contraindication to enteral feedings exists or as adjunctive therapy when full nutritional requirements cannot be met by TEN alone.