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Items 1 - 11 of 11 |
One page. |
[Analgesia and sedation in intensive care medicine.]
[Article in German]
Schaffrath E, Kuhlen R, Tonner PH.
Klinik fur Anasthesiologie, Klinikum der Universitat Munchen.
Sedation and analgesia are relevant aspects for the adequate treatment of patients in an intensive care unit. Recent drug developments and new strategies for ventilation provide improved sedation management allowing better adaptation to the clinical background and individual needs of the patient. This article provides an overview on the application of different substance groups. Focus is placed on newly developed pharmaceuticals such as dexmedetomidine. Another aspect is scoring system-related and EEG-based monitoring of depth of sedation. Modern concepts of analgesia and sedation for ICU patients have been developed based on the interaction of different parameters such as adaptive sedation and analgesia management (ASAM).
PMID: 15517111 [PubMed - as supplied by publisher]
Gastric vs small-bowel feeding in critically ill children receiving mechanical ventilation: a randomized controlled trial.
Meert KL, Daphtary KM, Metheny NA.
Critical Care Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA. kmeert@med.wayne.edu
STUDY OBJECTIVES: To determine the effect of feeding tube position (gastric vs small bowel) on adequacy of nutrient delivery and feeding complications, including microaspiration, in critically ill children. DESIGN: Randomized controlled trial. SETTING: Pediatric ICU in a university teaching hospital. PATIENTS: Seventy-four critically ill patients < 18 years of age receiving mechanical ventilation were randomized to receive gastric or small-bowel feeding. INTERVENTIONS: All feeding tubes were inserted at the bedside. Color, pH, and bilirubin concentration of the feeding tube aspirates were used to guide placement. Final tube position was confirmed radiographically. Continuous feedings were advanced to achieve a caloric goal based on age and body weight. Tracheal secretions were collected daily and tested for gastric pepsin by immunoassay. MEASUREMENTS AND RESULTS: Thirty-two patients were randomized to the gastric group, and 42 patients were randomized to the small-bowel group. Twelve patients exited the study because a small-bowel tube could not be placed at the bedside, leaving 30 patients in the small-bowel group. Gastric and small-bowel groups were similar at baseline in age, sex, percentage of ideal body weight, serum prealbumin concentration, and pediatric risk of mortality score. The percentage of daily caloric goal achieved was less in the gastric group compared to the small-bowel group (30 +/- 23% vs 47 +/- 22%, p < 0.01). No difference was found in the proportion of tracheal aspirates positive for pepsin between the gastric and small-bowel groups (50 of 146 aspirates vs 50 of 172 aspirates, respectively; p = 0.3). No differences were found in the frequency of feeding tube displacement, abdominal distension, vomiting, or diarrhea between groups. CONCLUSIONS: Small-bowel feeds allow a greater amount of nutrition to be successfully delivered to critically ill children. Small-bowel feeds do not prevent aspiration of gastric contents.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15364769 [PubMed - indexed for MEDLINE]
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Hand-carried ultrasound improves the bedside cardiovascular examination.
Kobal SL, Atar S, Siegel RJ.
Cardiac Non-Invasive Laboratory, Room 5335, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
OBJECTIVES: We assessed the clinical utility of hand-carried cardiac ultrasound (HCU) devices to assist physicians in the diagnosis of cardiovascular disease. MATERIALS AND METHODS: We reviewed 42 articles published from 1978 to 2004. RESULTS: The capability and simplicity of the HCU device assist physicians in the diagnosis of cardiovascular disease at the initial patients contact. HCU is particularly useful in the setting of emergency or critical care, community screening, or in remote areas with limited access to health care. CONCLUSION: The inherent limitations of the physical examination as well as the reduced focus and training in physical diagnosis of current and recent medical school graduates has set the stage for the HCU device to modify traditional medical practices by complementing the physical examination with real-time cardiovascular imaging.
Publication Types:
PMID: 15364744 [PubMed - indexed for MEDLINE]
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What is the current evidence on pain and sedation assessment in nonresponsive patients in the intensive care unit?
Li D, Puntillo K.
Department of Physiological Nursing, University of California, San Francisco, San Francisco, Calif, USA.
Assessing pain and sedation in nonresponsive patients is challenging. A major challenge is the confounding effect of sedation on objective indicators of pain. Clinicians might infer that adequate sedation means different patient states: promotion of amnesia, sleep/rest, patient safety, ventilator synchrony, and hemodynamic stability. Hence, an ideal measure that can adequately address the complexity and individualize the nature of the goals of pain and sedation therapy remains elusive. Furthermore, the behavioral responses to pain and anxiety/agitation (eg, restlessness, ventilator dyssynchrony, and movement) have many similarities. Tolerance to mechanical ventilation has been suggested to have validity in both an ICU pain scale and a sedation scale. Additional research is needed to establish the validity, sensitivity, and specificity of these pain indicators in sedated patients. In the meantime, in circumstances where patients are nonresponsive to external stimuli, clinicians should integrate other information such as actual or potential risks of pain (eg, extensiveness of injury, invasive therapies, intubation) and risks of pain-related functional impairment into their pain assessment in nonresponsive, sedated patients.
PMID: 15526492 [PubMed - in process]
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Learning portfolios--evidence of learning: an examination of students' perspectives.
Corcoran J, Nicholson C.
Clinical Teacher Critical Care, Western General Hospital, Edinburgh. janet.corcoran@luht.scot.nhs.uk
There is a lack of evaluative literature on the use of learning portfolios in nursing. Many students are still unclear on the benefit of using a learning portfolio, and fulfilling the criteria for the portfolios remains low priority. Over a 5-year period, tutors on the Specialist Practitioner Qualification in Critical Care found that there was a wide variety of practice in portfolio use. There is comparatively little known about how the students perceive the use of portfolios. Therefore, a small descriptive survey took place in 2001/2002 involving 22 previous students, to identify the value of portfolios from the student perspective. Recommendations from this study are given on how to improve portfolio use.
Publication Types:
PMID: 15462121 [PubMed - indexed for MEDLINE]
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The planning, organising and delivery of a memorial service in critical care.
Platt J.
Critical Care Unit Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2 9HT. jane.platt@lthtr.nhs.uk
The Intensive Care Society (1998) recommends that facilities should be available to follow up bereaved relatives. As part of bereavement follow up, a memorial service has been held at Royal Preston Hospital for the last three years. Over 300 people attended in 2003. A memorial service is often referred to as a ritual. Rituals seem to meet certain universal needs, such as confirming the reality of the death, assisting in the expression of feelings, stimulating memories of the deceased and providing support to the family and friends of the deceased. An audit in 2003 has confirmed the value of the service: 97% of attendees were glad they attended the service and 72% would like to be invited to the service again next year.
PMID: 15462120 [PubMed - indexed for MEDLINE]
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British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units.
Bray K, Hill K, Robson W, Leaver G, Walker N, O'Leary M, Delaney T, Walsh D, Gager M, Waterhouse C; British Association of Critical Care Nurses.
BACCN, Nurse Consultant Critical Care, Sheffield Teaching Hospitals, Sheffield, UK. kate.bray@sth.nhs.uk
Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.
Publication Types:
- Guideline
- Practice Guideline
PMID: 15462118 [PubMed - indexed for MEDLINE]
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Plugging the gap--critical care skills are the current universal commodity.
Adam S.
Publication Types:
PMID: 15462117 [PubMed - indexed for MEDLINE]
Effectiveness of neonatal intensive care for extremely low birth weight infants.
Kilbride HW.
Publication Types:
PMID: 15520140 [PubMed - in process]
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Effectiveness of neonatal intensive care for extremely low birth weight infants: in reply.
Doyle LW.
PMID: 15520139 [PubMed - in process]
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Palivizumab use in very premature infants in the neonatal intensive care unit.
Wu SY, Bonaparte J, Pyati S.
Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois 60612, USA. sywhuang@comcast.net
OBJECTIVE: The purpose of this study was to determine the ability of young hospitalized premature (born < or =30 weeks' gestational age) infants to achieve serum levels of palivizumab that are protective against RSV infection. METHODS: Palivizumab, 15 mg/kg per dose intramuscularly, was administered every 28 days to stable premature infants who were hospitalized in the neonatal intensive care unit starting at 1 month of postnatal life. Palivizumab concentrations were assayed in serum samples that were drawn from infants who remained in the hospital at 14 days (midpoint concentration) and at 28 days (trough concentration) after each dose was administered. RESULTS: The gestational age of the 24 infants who were enrolled was 27.5 +/- 1.8 weeks (mean +/- standard deviation), and birth weight was 928 +/- 159 g. Midpoint palivizumab concentrations in the 24 infants after the first dose were 45.6 +/- 13.0 microg/mL; 71% (17 of 24) of the infants maintained optimal palivizumab concentrations (> or =40 microg/mL). The concentrations dropped subsequently; trough concentrations just before the second dose were 32.2 +/- 10.5 microg/mL, and only 23% (5 of 22) of the infants had concentrations in the optimal range. Sixteen infants were given 2 doses and 6 were given three doses of palivizumab while in the neonatal intensive care unit. Midpoint concentrations after the second dose were significantly higher than those after the first dose. Likewise, trough concentrations before the third dose were 51.9 +/- 7.8 microg/mL and higher than those before the second dose; the concentrations were >40 microg/ml in all 6 infants tested. CONCLUSIONS: Very premature infants had sustained optimal protective serum concentrations only after the second dose of palivizumab; 77% of infants tested had trough concentrations <40 microg/mL before the second dose. Additional studies are needed to establish the optimal timing of the initial dose and optimal dosing interval of palivizumab in this most vulnerable population.
PMID: 15520088 [PubMed - in process]
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