Intensive care units syndrome

This drug has sedative and anticonvulsant properties. Its use in anaesthesia is now almost exclusively reserved for the management of acute withdrawal syndromes in the intensive care unit. It is thought that clomethiazole enhances GABAergic transmission in the brain. At normal dosages it has little effect on the cardiovascular system. 

M, metaboiism S, at or near site of action IV, intravenously MHS, malignant hyperthermia syndrome ALA, aianine ICU, intensive care unit CNS, central nervous system MAOI, monoamine oxidase inhibitor, NSAID, non-steroidal anti-inflammatory drug ACE, angiotensin in-converting enzyme 5-HT, 5-hydrox ryptamine. 

Over the next several years, she had recurrent episodes of reactive airway disease. At the age of 4 years, she had a life-threatening episode of acute chest syndrome requiring admission to the intensive care unit and exchange transfusion. She was subsequently transfused with red blood cells monthly for 6 months to prevent recurrence. Two years later, she was again admitted to the intensive care unit with acute chest syndrome. During this admission, she was found to have Streptococcus pneumoniae sepsis and pneumonia. She again received RBC transfusions monthly for 6 months. Following this course of transfusion therapy, she was offered therapy with hydroxyurea, but this therapy was never instituted. 

Intensive care Patients with ALE or with decompensated chronic liver insufficiency (such as coma stages II-IV, refractory ascites, hepatorenal syndrome, disseminated intravascular coagulation, gastrointestinal bleeding) require monitoring and treatment in an intensive care unit, preferably in a transplantation centre. (7,13,60, 66, 77)... 

A 15-year-old woman intentionally took 10 modified-release tablets of diltiazem 200 mg. She developed hypertension, oliguria, pulmonary edema, and respiratory distress syndrome, and required mechanical ventilation for 3 days, besides intravenous calcium, dopamine, and noradrenaline. After 5 days in an intensive care unit, she was transferred to a psychiatric hospital in good physical condition (22). 

Five adults with head injuries inexplicably had fatal cardiac arrests in a neurosurgical intensive care unit after the introduction of a sedation formulation containing an increased concentration of propofol (72). There were striking similarities with the previously reported syndrome of myocardial failure, metabolic acidosis, and rhabdomyolysis in children who received high-dose propofol infusions for more than 48 hours. 

Once one knows the problem and has devised a solution, then the real job begins. National Center for Health Statistics data show a decline in total US infant mortality from 1982 to 1992, but marked geographic and racial differences remain. The 1992 overall US rate of infant death was 8.5 per 1000 live births (California, 6.9 Texas, 7.7 New York, 8.5 New Jersey, 8.5 Pennsylvania, 8.6 Ohio, 8.7 Florida, 9.1 Illinois, 10.0 Georgia, 10.4 Michigan, 10.5) - a decline attributed not to reductions in the numbers of birth defects or premature births but to improved neonatal intensive care units and the introduction of synthetic pulmonary surfactants and consequent reductions in death from acute neonatal respiratory distress syndrome. Still, the years of potential life lost due to birth defects ranks fifth, just behind that of homicide and suicide (1, unintentional injury 2, cancer 3, cardiovascular disease) prematurity/low birth weight ranks sixth and sudden infant death syndrome seventh. Ethnic discrepancy remains pronounced rates of White (5.8 per 1000 live births) and Cuban Hispanic (3.7 per 1000 live births) infant death are similar, but the 2002 rate for Blacks (13.9 per 1000 live births) increased compared to the previous year. 

Raymond et al. reported on a rotation study in a surgical intensive care unit with a different twist.Patients were stratified as either having sepsis/peritonitis or pneumonia, and empiric therapy was cycled every 3 months by syndrome. Fourteen hundred fifty-six admissions and 540 infections were treated over a 2-year period. With similar severity of illness during the before and after periods (mean APACHE II = 19), the authors demonstrated a reduction of length of stay from a mean of 62 days to 39 days, a reduction of vancomycin-resistant enterococcal and methicillin-resistant staphylococcal infection from 14 per 100 admissions to 8 per 100 admissions and death due to any cause dropped from 25 in the before period to 18 in the rotation period. Antimicrobial susceptibility and several other key parameters needed to evaluate the effectiveness of this program were not reported. 

It is, in part, the irreversibility of failure cascades that makes them so formidable. In medicine such failure cascades may be manifest as multiple organ dysfunction syndrome (MODS) that rapidly accumulates following a minor insult MODS is the leading cause of death in intensive care units. As Buchman [108] points out ... 

Multiple studies have addressed the role of thyroid supplementation in critically ill patients with cardiac disease, sepsis, pulmonary disease (e.g., acute respiratory distress syndrome), or severe infection, or with burn and trauma patients. In spite of a very large number of published studies, it is very difficult to form clear recommendations for treatment with thyroid hormone in the intensive care unit. 

Liano F, Junco E, Pascual J, Madero R, Verde E The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int SuppI 66 S16-S24, 1998 Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273 117-123, 1995... 

Injecting a gas into the circulation may seem potentially hazardous,but extensive clinical experience has shown that the tiny volume of the air or gas given (<200 jJ) is not dangerous, and the safety of microbubbles compares well with that of conventional agents in radiography and MRl (Nanda and Carstensen 1997). At the moment, the use of SonoVue is not permitted in mechanically ventilated intensive care unit patients and in patients with heart failure, right-to-left shunts of the heart, uncontrolled hypertension and adult respiratory distress syndrome. 

Drug withdrawal A withdrawal syndrome has been described after the use of remifenta-nil by infusion in intensive care units [166 ]. Within 10 minutes of withdrawal, patients experienced tachycardia, hypertension, sweating, mydriasis, and myoclonus. These symptoms persisted despite the use of morphine and clonidine and only resolved on readministration of remifentanil. Gradual tapering of remifentanil reduces the incidence of withdrawal symptoms. 

Frantzeskaki F, Paramythiotou E, Papathanasiou M, Athanasios G, Gouliamos A, Armaganidis A. Posterior reversible encephalopathy syndrome in an intensive care unit patient receiving tacrolimus. Acta Anaesthesiol Scand 2008 52(8) 1177. 

Kiikoyi A, Coker S, Lewis L, Nierenberg D. Two cases of acute dexmedetomidine withdrawal syndrome following prolonged infusion in the intensive care unit report of cases and review of the Hterahrre. Hum Exp Toxicol January 2013 32(1) 107-10. 

Granberg A, Engberg JB, Lundberg D. Patients experience of being critically ill ot severely injured and care for in an intensive care unit in relation to the ICU syndrome. Part 1. Intensive Grit Gare Nuts 1998 14 294-307. 

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