Cardiovascular drugs

2019 ◽  
pp. 177-204
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Adverse Effects ◽  
Critically Ill ◽  
Phosphodiesterase Inhibitors ◽  
Antiplatelet Agents ◽  
Cardiovascular Drugs ◽  
Haemodynamic Instability ◽  
Adrenergic Agonists

Haemodynamic instability is one of the main reasons for admission to critical care. Often patients will require medication to provide cardiovascular support. This chapter discusses cardiovascular drugs and includes discussion on β‎-adrenergic agonists, phosphodiesterase inhibitors, vasodilators, vasopressors, antiarrhythmics in intensive care, chronotropes, antianginal agents, antiplatelet agents, diuretics and the critically ill, and levosimendan. These medications are part of the daily practise in intensive care. Knowledge of the indications, interactions, and adverse effects is essential.

Cardiovascular drugs

2011 ◽  
Author(s):  
Carl Waldmann ◽  
Neil Soni ◽  
Andrew Rhodes
Keyword(s):  
Cardiac Output ◽  
Critical Care ◽  
Critically Ill ◽  
Phosphodiesterase Inhibitors ◽  
Antiplatelet Agents ◽  
Cardiovascular Drugs ◽  
Antiarrhythmic Agents ◽  
Adrenergic Agonists ◽  
Adrenergic Agents

β‎-Adrenergic agonists 166Phosphodiesterase inhibitors 168Vasodilators 170Vasopressors 174Antiarrhythmic agents 176Chronotropes 178Antianginal agents 182Antiplatelet agents 184Diuretics and the critically ill 186Levosimendan 190β‎-Adrenergic agents are used commonly for cardiovascular support in critical care to increase cardiac output via ...

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

Cases in Paediatric Critical Care Transfer and Retrieval Medicine

2021 ◽  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Transfer Process ◽  
The Past ◽  
Clinical Presentations ◽  
Paediatric Critical Care ◽  
Care Transfer ◽  
Case Based

Critically ill paediatric transfers have expanded rapidly over the past ten years and, as such, the need for transfer teams to recognise, understand and treat the various illnesses that they encounter is greater than ever. This highly illustrated book covers a multitude of clinical presentations in a case-based format to allow an authentic feel to the transfer process. Written by clinicians with experience in thousands of transfers, it brings together many years of experience from a world-renowned hospital. Following the case from initial presentation, to resuscitation and referral and finally with the transfer itself; the book explores the clinical stabilisation, human factors decisions and logistical challenges that are encountered every day by these teams. Following the entire journey, this is an ideal resource for all professionals who may be involved in critical care transfer and retrieval medicine, particularly those working in paediatrics, emergency medicine, anaesthesiology, intensive care, or pre-hospital settings.

Survey of Physiotherapy Practice in Ontario Cardiac Surgery Intensive Care Units

2021 ◽  
pp. e20200069
Author(s):  
Anastasia N.L. Newman ◽  
Michelle E. Kho ◽  
Jocelyn E. Harris ◽  
Alison Fox-Robichaud ◽  
Patricia Solomon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Critically Ill ◽  
Outcome Measures ◽  
Median Number ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Physiotherapy Practice

Purpose: This article describes current physiotherapy practice for critically ill adult patients requiring prolonged stays in critical care (> 3 d) after complicated cardiac surgery in Ontario. Method: We distributed an electronic, self-administered 52-item survey to 35 critical care physiotherapists who treat adult cardiac surgery patients at 11 cardiac surgical sites. Pilot testing and clinical sensibility testing were conducted beforehand. Participants were sent four email reminders. Results: The response rate was 80% (28/35). The median (inter-quartile range) reported number of cardiac surgeries performed per week was 30 (10), with a median number of 14.5 (4) cardiac surgery beds per site. Typical reported caseloads ranged from 6 to 10 patients per day pe therapist, and 93% reported that they had initiated physiotherapy with patients once they were clinically stable in the intensive care unit. Of 28 treatments, range of motion exercises (27; 96.4%), airway clearance techniques (26; 92.9%), and sitting at the edge of the bed (25; 89.3%) were the most common. Intra-aortic balloon pump and extracorporeal membrane oxygenation appeared to limit physiotherapy practice. Use of outcome measures was limited. Conclusions: Physiotherapists provide a variety of interventions with critically ill cardiac surgery patients. Further evaluation of the limited use of outcome measures in the cardiac surgical intensive care unit is warranted.

Postoperative Delirium: A Literature Review of Management in Intensive Care Unit

2021 ◽  
Vol 1 (3) ◽  
pp. 44-48
Author(s):  
Cendy Legowo
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Postoperative Delirium ◽  
Mechanistic Explanation ◽  
Clinical Results ◽  
Care Plan ◽  
Prevention And Treatment

Perioperative delirium is a wide-ranging problem that directly affects primary clinical results. The anesthesiologist must understand how to define and diagnose delirium, identify patients at high risk of delirium, identify predisposing factors to adjust the care plan appropriately, and manage delirium in the acute postoperative period. Delirium is an organ dysfunction in critically ill patients, independently associated with improved morbidity. Research on delirium in hospitalized patients (including critically ill patients) has increased exponentially in the last decade. This study emphasizes the need for a mechanistic explanation of delirium to help advance the research that ultimately leads to its prevention and treatment. In this study, multinational and multidisciplinary clinicians, and researchers from the fields of critical care medicine, psychiatry, anesthesiology, neurology, and pharmacy sought to collaborate in the management of delirium in the intensive care unit (ICU).

scholarly journals Implementation of the Critical Care Pain Observation Tool

2018 ◽  
Author(s):  
Carla Salvadore
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Pain Assessment ◽  
The United States ◽  
Posttest Score ◽  
Assessment Instrument ◽  
Post Intervention ◽  
Nurses Knowledge

In the United States, greater than half of the adult patients who are admitted to critical care experience pain and report poor pain control. Inadequate management of acute pain is associated with negative outcomes, including high blood sugar, insulin resistance, higher infection risk, increased discomfort, decreased satisfaction, and chronic pain. Patients in the intensive care unit (ICU) cannot always express that they are having pain. Recently modified guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult recommend a reliable and valid pain assessment instrument for patients who are unable to verbalize pain. For the adult critically ill population, the Critical Care Pain Observation Tool (CPOT) and the Behavioral Pain Scale (BPS) were identified as the most reliable and valid instruments. The purpose of this program development was to provide education for nurses in the Cardiovascular Intensive Care Unit (CVICU) on the CPOT to assist in transitioning to the CPOT as part of the CVICU pain assessment. A pretest-posttest design was utilized to evaluate the nurses’ knowledge of the CPOT. The intervention consisted of a one-hour education session on pain assessment and the CPOT. Thirteen out of a potential twenty-two nurses (n=13, 59%) participated in the educational session with a mean pretest score of 42.3% and a mean posttest score of 93.1%. There was a 50.8% improvement post-intervention total scores. Findings from this quality improvement education intervention suggest that the CVICU nurses’ knowledge increased in both pain assessment and the CPOT following the intervention.

scholarly journals Rapid Critical Care Training of Nurses in the Surge Response to the Coronavirus Pandemic

2020 ◽  
Vol 29 (5) ◽  
pp. e104-e107
Author(s):  
Diana Brickman ◽  
Andrew Greenway ◽  
Kathryn Sobocinski ◽  
Hanh Thai ◽  
Ashley Turick ◽  
...  
Keyword(s):  
New York ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
New York State ◽  
Care Staff ◽  
Critical Care Nursing ◽  
Care Nursing

Background In response to the coronavirus pandemic, New York State mandated that all hospitals double the capacity of their adult intensive care units In this facility, resources were mobilized to increase from 104 to 283 beds. Objective To create and implement a 3-hour curriculum to prepare several hundred non–critical care staff nurses to manage critically ill patients with coronavirus disease 2019. Methods Critical care nursing leaders and staff developed and implemented a flexible critical care nursing curriculum tailored to the diverse experience, expertise, and learning needs of non–critical care nursing staff who were being redeployed to critical care units during the surge response to the pandemic. Curricular elements included respiratory failure and ventilator management, shock and hemodynamics, pharmacotherapy for critical illnesses, and renal replacement therapy. A skills station allowed hands-on practice with common critical care equipment. Results A total of 413 nurses completed training within 10 days. As of June 2020, 151 patients with coronavirus disease 2019 still required mechanical ventilation at our institution, and 7 of 10 temporary intensive care units remained operational. Thus most of the nurses who received this training continued to practice critical care. A unique feature of this curriculum was the tailored instruction, adapted to learners’ needs, which improved the efficiency of content delivery. Conclusions Program evaluation is ongoing. As recovery and restoration proceed and normal operations resume, detailed feedback from program participants and patient care managers will help the institution maintain high operational readiness should a second wave of critically ill patients with coronavirus disease 2019 be admitted.

The Meaning of Our Work

2011 ◽  
Vol 22 (4) ◽  
pp. 397-407
Author(s):  
Clareen A. Wiencek ◽  
Betty R. Ferrell ◽  
Molly Jackson
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Moral Distress ◽  
Survival Rates ◽  
Critically Ill Patient ◽  
Current Profile ◽  
Patients With Cancer ◽  
A Current

The prevalence and survival rates of critically ill patients with cancer in the intensive care unit have increased considerably in the past 2 decades; yet, the meaning of caring for cancer patients in this setting may fall along a continuum. This article addresses the nurse’s experience in caring for the critically ill patient with cancer by presenting a current profile of these patient in the intensive care unit in the context of the historical development and mission of critical care and the evolution of cancer as a chronic disease. The moral distress that can result when these 2 “cultures” or “realities” collide and the meaning of the nurse’s work will be examined. Strategies and resources for critical care nurses to incorporate into their practice when caring for the critically ill patient with cancer, and themselves, will be addressed.

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