Ultimo Aggiornamento: 3 Febbraio 2004

1: Anaesthesia. 2003 Dec;58(12):1178-83.

Critical care.

Ridley S.

Norfolk and Norwich University, Norwich, UK. saxon@domum.globalnet.co.uk

Publication Types:
Review
Review, TutorialPMID: 14705678 [PubMed - indexed for MEDLINE]

2: Anaesthesia. 2004 Jan;59(1):34-7.

Simple bedside assessment of level of consciousness: comparison of two simple
assessment scales with the Glasgow Coma scale.

McNarry AF, Goldhill DR.

Department of Anaesthesia and Critical Care, Royal London Hospital, Barts and
the London NHS Trust, Alexandra Wing, The Royal London Hospital, Whitechapel,
London E1 1BB, UK. al@thegasman.fsnet.co.uk

Neurological assessment is an essential component of early warning scores used
to identify seriously ill ward patients. We investigated how two simple scales
(ACDU - Alert, Confused, Drowsy, Unresponsive; and AVPU - Alert, responds to
Voice, responds to Pain, Unresponsive) compared to each other and also to the
more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded
patients' conscious level with each of the three scales. Over 7 months, 1020
analysable measurements were collected. Both simple scales identified distinct
GCS ranges, although some overlap occurred (p < 0.001). Median GCS scores
associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6.
The median values of ACDU were more evenly distributed than AVPU and may
therefore be better at identifying early deteriorations in conscious level when
they occur in critically ill ward patients.

PMID: 14687096 [PubMed - indexed for MEDLINE]

3: Anesth Analg. 2004 Feb;98(2):461-8.

Is there still a place for dopamine in the modern intensive care unit?

Debaveye YA, Van Den Berghe GH.

Department of Intensive Care Medicine, Catholic University of Leuven, Leuven,
Belgium.

For many years, dopamine was considered an essential drug in the intensive care
unit (ICU) for its cardiovascular effects and, even more, for its supposedly
protective effects on renal function and splanchnic mucosal perfusion. There is
now ample scientific evidence that low dose dopamine is ineffective for
prevention and treatment of acute renal failure and for protection of the gut.
Until recently, low-dose dopamine was considered to be relatively free of side
effects. However, it is now clear that low-dose dopamine, besides not achieving
the preset goal of organ protection, may also be deleterious because it can
induce renal failure in normo- and hypovolemic patients. Furthermore, dopamine
may cause harm by impairing mucosal blood flow and by aggravating reduced
gastric motility. Dopamine also suppresses the secretion and function of
anterior pituitary hormones, thereby aggravating catabolism and cellular immune
dysfunction and inducing central hypothyroidism. In addition, dopamine blunts
the ventilatory drive, increasing the risk of respiratory failure in patients
who are being weaned from mechanical ventilation. We conclude that there is no
longer a place for low-dose dopamine in the ICU and that, in view of its side
effects, its extended use as a vasopressor may also be questioned.

PMID: 14742388 [PubMed - in process]

4: Br J Anaesth. 2004 Jan;92(1):54-60.

Strong ions, weak acids and base excess: a simplified Fencl-Stewart approach to
clinical acid-base disorders.

Story DA, Morimatsu H, Bellomo R.

Department of Anaesthesia, and Department of Intensive Care, Austin and
Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia.
David.Story@austin.org.au

BACKGROUND: The Fencl-Stewart approach to acid-base disorders uses five
equations of varying complexity to estimate the base excess effects of the
important components: the strong ion difference (sodium and chloride), the total
weak acid concentration (albumin) and unmeasured ions. Although this approach is
straightforward, most people would need a calculator to use the equations. We
proposed four simpler equations that require only mental arithmetic and tested
the hypothesis that these simpler equations would have good agreement with more
complex Fencl-Stewart equations. METHODS: We reduced two complex equations for
the sodium-chloride effect on base excess to one simple equation:
sodium-chloride effect (meq litre(-1))=[Na(+)]-[Cl(-)]-38. We simplified the
equation of the albumin effect on base excess to an equation with two constants:
albumin effect (meq litre(-1))=0.25x(42-[albumin]g litre(-1)). Using 300 blood
samples from critically ill patients, we examined the agreement between the more
complex Fencl-Stewart equations and our simplified versions with Bland-Altman
analyses. RESULTS: The estimates of the sodium-chloride effect on base excess
agreed well, with no bias and limits of agreement of -0.5 to 0.5 meq litre(-1).
The albumin effect estimates required log transformation. The simplified
estimate was, on average, 90% of the Fencl-Stewart estimate. The limits of
agreement for this percentage were 82-98%. CONCLUSIONS: The simplified equations
agree well with the previous, more complex equations. Our findings suggest a
useful, simple way to use the Fencl-Stewart approach to analyse acid-base
disorders in clinical practice.

PMID: 14665553 [PubMed - indexed for MEDLINE]

5: Crit Care Nurse. 2003 Dec;23(6):81.

The first element of negligence.

Ashley RC.

PMID: 14692175 [PubMed - indexed for MEDLINE]

6: Crit Care Nurse. 2003 Dec;23(6):74-80.

An MSN curriculum in preparation of CCNSs: a model for consideration.

Cox CW, Galante CM.

School of Nursing & Health Studies, Georgetown University, Washington, DC, USA.

PMID: 14692174 [PubMed - indexed for MEDLINE]

7: Crit Care Nurse. 2003 Dec;23(6):61-6.

Argatroban, a new treatment option for heparin-induced thrombocytopenia.

Cleveland KW.

Idaho Drug Information Service, Idaho State University College of Pharmacy,
Pocatello, Idaho, USA.

Publication Types:
Review
Review, TutorialPMID: 14692173 [PubMed - indexed for MEDLINE]

8: Crit Care Nurse. 2003 Dec;23(6):34-41.

Blood management strategies for critical care patients.

Vernon S, Pfeifer GM.

Bloodless Medicine and Surgery Institute, Mentor, Ohio, USA.

Publication Types:
Review
Review, TutorialPMID: 14692170 [PubMed - indexed for MEDLINE]

9: Crit Care Nurse. 2003 Dec;23(6):14-22, 24-6, 28 passim; quiz 31-2.

Rhabdomyolysis. Pathophysiology, recognition, and management.

Criddle LM.

Emergency Department, Trauma/Neuro Intensive Care Unit, Oregon Health & Science
University, Portland, Ore., USA.

Rhabdomyolysis is a clinical syndrome in which the contents of injured muscle
cells leak into the circulation. This leakage results in electrolyte
abnormalities, acidosis, clotting disorders, hypovolemia, and acute renal
failure. More than 100 conditions, both traumatic and non-traumatic, can lead to
rhabdomyolysis. Intervention consists of early detection, treatment of the
underlying cause, volume replacement, urinary alkalinization, and aggressive
diuresis or hemodialysis. Patients with rhabdomyolysis often require intensive
care, and critical care nurses are instrumental in both the early detection and
the ongoing management of this life-threatening syndrome.

Publication Types:
Case Reports
Review
Review, AcademicPMID: 14692169 [PubMed - indexed for MEDLINE]

10: JAMA. 2004 Jan 21;291(3):287-8.

Physicians apply genome research to treating critical illness and injury.

Hampton T.

Publication Types:
NewsPMID: 14734572 [PubMed - indexed for MEDLINE]