Home About us Contact
|
Home About us Contact | ||
|
|
||
Surgical ICU (surgical + icu)
Selected AbstractsEarly predictability of the need for tracheotomy after admission to ICU: an observational studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010D. P. VEELO Background: The goal of this study was to explore the ability of professional judgment to predict the need for tracheotomy early among intensive care unit (ICU) patients. Methods: Prospective study using daily questionnaires among ICU physicians in a mixed medical,surgical ICU. The prediction of tracheotomy was by a visual analogue scale (VAS, from 1 to 10, with 1 representing ,absolutely no need for tracheotomy' and 10 representing ,pertinent need for tracheotomy') during ICU stay until tracheal extubation or tracheotomy. For the purpose of this study, a VAS score ,8 was considered a positive prediction for tracheotomy. Results: A total of 476 questionnaires were retrieved for 75 patients (6.4±5.2 questionnaires per patient), of which 11 patients finally proceeded with a tracheostomy. At first assessment (mean of 2.4±0.8 days after ICU admittance), ICU physicians predicted the need for tracheotomy 3.0 (2.0,6.0) higher VAS points for patients who were finally tracheotomized (P<0.01). Patients with a positive prediction had a 5.4 (1.2,24.1) higher chance of receiving tracheotomy (P=0.03). Considering the median VAS score over a maximum of 10 days before tracheotomy, ICU physicians scored tracheotomized patients significantly higher from day 8 onwards. When comparing ICU physicians, fellows and residents separately, only staff physicians scored a significant difference in the VAS score (P<0.05). Conclusion: ICU physicians are able to differentiate between patients in need for tracheotomy from those who do not, within 2 days from admittance. The closer the time to the actual intervention, the better the physicians are able to predict this decision. [source] Pharmacokinetics and analgesic effects of intravenous propacetamol vs rectal paracetamol in children after major craniofacial surgeryPEDIATRIC ANESTHESIA, Issue 7 2008SANDRA A. PRINS MD PhD Summary Background:, The pharmacokinetics and analgesic effects of intravenous and rectal paracetamol were compared in nonventilated infants after craniofacial surgery in a double-blind placebo controlled study. Methods:, During surgery all infants (6 months,2 years) received a rectal loading dose of 40 mg·kg,1 paracetamol 2 h before anticipated extubation. On admittance to the pediatric surgical ICU, the children were randomized to receive either a 15 min intravenous infusion of 40 mg·kg,1 propacetamol, a prodrug of paracetamol, or 20 mg·kg,1 paracetamol rectally every 6 h. A population pharmacokinetic analysis of the paracetamol plasma concentration time-profiles was undertaken using nonlinear mixed effects models. The visual analogue scale (VAS) (score 0,10 cm) and COMFORT Behavior scale (score 6,30) were used to monitor analgesia in the 24-h period following surgery. Results:, Twelve infants received intravenous propacetamol and 14 paracetamol suppositories. Paracetamol pharmacokinetics were described according to a two-compartmental model with linear disposition. Pharmacokinetic parameters were standardized to a 70 kg person using allometric ,1/4 power' models. Parameter estimates were: absorption half-life from the rectum 4.6 h, propacetamol hydrolysis half-life 0.028 h, clearance 12 l·h,1·70 kg,1, intercompartmental clearance 116 l·h,1·70 kg,1, central and peripheral volume of distribution 7.9 and 44 l·70 kg,1, respectively. During the 24-h study period 22 infants exhibited VAS scores <4 cm, which was considered a cutoff point. On single occasions four patients, two in each group, exhibited a VAS score ,4 cm. Nine patients in the rectal treatment group and three patients in the intravenous treatment group received midazolam for COMFORT-B scores exceeding 17 (P < 0.05). Conclusions:, Intravenous propacetamol proved to be more effective than rectal paracetamol in infants after craniofacial surgery. Midazolam was more frequently administered to patients receiving paracetamol suppositories, indicating that these children experienced more distress, possibly caused by pain. [source] Intensive insulin treatment in coronary and intensive carePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2007Dr C Jones MRCP, MB ChB Specialist Registrar Abstract Hyperglycaemia in the setting of acute illness carries a poor prognosis. The first Diabetes and Insulin-Glucose infusion in Acute Myocardial Infarction (DIGAMI) study demonstrated a reduction in total mortality with intravenous insulin to reduce hyperglycaemia followed by multi-dose subcutaneous insulin in diabetic patients following myocardial infarction. Unfortunately, there were several problems with the follow-up DIGAMI-2 study, so that it is not clear if maximum benefit was obtained by intravenous insulin, subcutaneous insulin, or a combination of both. In the surgical intensive care unit (ICU) setting, intensive insulin to restore normoglycaemia reduced total mortality in patients admitted to a surgical ICU who developed hyperglycaemia. In a follow-up study in medical ICU patients the results were disappointing, and there was no overall reduction in mortality. There is a need for a study which would combine these two complementary approaches, examining the possible benefits of using very intensive insulin treatment to achieve normoglycaemia following myocardial infarction in patients with diabetes. Copyright © 2007 John Wiley & Sons. [source] Comparing Norwegian nurses' and physicians' perceptions of the needs of significant others in Intensive Care UnitsJOURNAL OF CLINICAL NURSING, Issue 5 2005Christina Takman CCRN Aim and objectives., To illuminate and compare the perceptions of registered nurses (n = 243) and physicians (n = 29) in medical and surgical ICUs for adults on the needs of significant others. Background., Previous studies have established the necessity for healthcare professionals in Intensive Care Units (ICUs) to identify and meet the needs of critically ill adult patients' significant others. Design., A survey was conducted and data from the Critical Care Family Needs Inventory were analysed using descriptive and inferential statistics. Results., The findings revealed four factors: ,attentiveness and assurance', ,taking care of themselves', ,involvement', and ,information and predictability'. Nurses scored higher than physicians on ,attentiveness and assurance'. Nurses with experience of being a patient or a significant other in an ICU placed a higher value on ,involvement' compared with nurses without such experience, while physicians with such experience scored higher on ,information and predictability' compared with those without such experience. Older physicians and those with extensive professional and ICU experience had a low score on ,involvement', but scored higher on ,information and predictability' compared with physicians with less experience. Nurses with extensive ICU and professional experience also scored higher on ,information and predictability' than nurses with less experience. Women placed a higher value on each of the four factors than men. Conclusion., The study revealed variations in ICU professionals' perceptions of significant others' needs. Relevance to clinical practice., There is a need for nurses and physicians to acknowledge that varying perceptions on significant others needs could lead to different ways of conducting themselves in encounters with significant others in ICUs. There is also a risk that the patients' significant others could be forced to adapt themselves to professionals' different and perhaps contradictory perceptions of their needs in ICUs. [source] | ||||||||||