摘要:

Little data exists concerning the details of education in the critical care setting. Most of the studies have been done by the nursing profession, examining techniques to improve orientation, continuing education, and methods of teaching. In addition, some newer methodologies have recently been developed that may aid the process, and the roles of other health care professions have increased. This review examines these recent developments and possible ways to exploit their experience to improve critical care education.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Recent developments in nutrition support have continued to focus on the gastrointestinal tract as an important part of host defense following injury. Immunosuppression and subsequent infections are a major problem in critically ill and critically injured patients, and aggressive nutrition support is necessary to avoid progressive protein or calorie malnutrition. Altered gastrointestinal permeability and mucosal immunity have received significant attention as important factors in improving host defenses influenced by nutrition. Specialty formulas show significant promise in supporting the critically ill patient and maximizing the opportunity for recovery without infectious morbidity. Evidence supporting enteral rather than parenteral nutrition continues to mount.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In the past 5 to 10 years, neuromuscular blocking agents have become more popular in critical care as adjuvants to mechanical ventilation in the treatment of respiratory failure. The explanation for this change from an era of partial ventilatory support in the 1970s and early 1980s when intermittent mandatory ventilation was popular and neuromuscular blocking agents were almost never used is based on new forms of mechanical ventilation that include pressure-control ventilation and pressure-control inverse ratio ventilation. The driving force behind pressure-control ventilation and pressure-control inverse ratio ventilation has been the high mortality rate in patients with adult respiratory distress syndrome. Unfortunately, neuromuscular blocking agents have their own serious complications, which include persistent weakness and delayed weaning from the ventilator. Just when it was hoped that new forms of ventilation might reduce pressure and volume damage to the lung and reduce the mortality rate of patients with adult respiratory distress syndrome, one of the agents often needed to permit the use of pressure-control ventilation and pressure-control inverse ratio ventilation turns out to be less than risk free. This article will explore the dilemma of the modern intensivist attempting to treat patients with adult respiratory distress syndrome with a new form of ventilation while needing drugs that are inherently troublesome in the ICU.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Lactate levels have increasingly been used as indicators of adequacy of resuscitation. This paper reviews the metabolic pathways of lactate and discusses the utility and pitfalls of serum lactate determinations. Lactate levels correlate well with survival in patients with septic shock and are better predictors of survival than oxygen-derived variables. Therapy of lactic acidosis by use of Carbicarb (International Medical Systems, South El Monte, CA) or dichloroacetate may be promising.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The critically ill patient is often characterized by unique pharmacokinetic findings because of the dynamic nature of their illness and the common presence of multiple organ system dysfunction. Pharmacokinetics in the ICU patient are affected by altered volumes of distribution, altered protein binding, changes in liver and renal blood flow, hypoxia, and cytokines. Once-daily administration of aminoglycosides has been an area of interest within the past few years. Once-daily administration appears to be at least as effective and no more toxic than traditional dosing regimens. The enthusiasm of therapeutic drug monitoring in vancomycin dosing has diminished recently because of a lack of correlation between serum concentration and efficacy or toxicity. Well-designed outcome studies addressing therapeutic drug monitoring of a wide variety of drugs are lacking. Evidence does suggest that therapeutic drug monitoring decreases toxicity, but evidence regarding efficacy is more difficult to locate. Several studies have shown therapeutic drug monitoring to be cost-effective. Further research is needed to evaluate the effects of therapeutic drug monitoring on clinical outcomes in ICU patients.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Recognition of shock in surgical patients is still a challenge. Simple physical signs can be misleading. Invasive monitoring techniques, which were developed 10 to 20 years ago to assess global hemodynamics, are being reevaluated and shown to have limitations. These techniques do not always result in an improved prognosis, and their reliability in septic patients may be poor. There is a growing drive in favor of noninvasive monitoring techniques, such as transesophageal echocardiography, which appear very promising. Monitoring individual organs to detect “compensated shock” and treat regional hypoperfusion is becoming more important. Detecting and preventing gut hypoperfusion may significantly affect outcome in surgical patients. Finally the need for monitoring of surgical patients is reemphasized; there is still evidence of undermonitoring.

ISSN:1070-5295    

出版商:OVID    

年代:1995

数据来源: OVID