Prolonged critical illness: management of long-term acute care
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2001
|
| Schriftenreihe: | Clinics in chest medicine
22,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 223 S. Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Prolonged critical illness |b management of long-term acute care |c Alexander C. White ... guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2001 | |
| 300 | |a XIV, 223 S. |b Ill., graph. Darst. | ||
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| 490 | 1 | |a Clinics in chest medicine |v 22,1 | |
| 650 | 7 | |a Chronisch zieken |2 gtt | |
| 650 | 7 | |a Intensive care |2 gtt | |
| 650 | 2 | |a Maaladie grave | |
| 650 | 2 | |a Maladie chronique | |
| 650 | 2 | |a Soins longue durée | |
| 650 | 4 | |a Chronic Disease | |
| 650 | 4 | |a Chronically ill |x Care | |
| 650 | 4 | |a Critical Care | |
| 650 | 4 | |a Critical Illness | |
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Datensatz im Suchindex
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| adam_text | PROLONGED CRITICAL ILLNESS:
MANAGEMENT OF LONG TERM ACUTE CARE
CONTENTS
Preface xiii
Alexander C. White and Barry L. Fanburg
The Evolution of Care for the Chronically Critically 111 Patient 1
Lawrence S. Hotes and Edward Kalman
The evolution of care for the chronically critically ill patient has resulted
in the development of specialized ventilator units in long term acute care
hospitals. By developing a multidisciplinary approach to patient care,
these units have helped optimize outcomes for this challenging patient
population. This article reviews how these units evolved over the last 10
to 15 years, the system of payment and regulation, and the future of these
units in the managed care environment.
Weaning from Prolonged Mechanical Ventilation 13
Michael L. Nevins and Scott K. Epstein
Although most patients who need invasive mechanical ventilation can be
easily liberated from the ventilator, a significant number fail repeated
weaning attempts and require prolonged mechanical ventilation. The de¬
velopment of weaning failure and need for prolonged mechanical ventila¬
tion is multifactorial in origin, involving disorders of pulmonary mechan¬
ics and complications associated with critical illness. Although there is a
burgeoning literature focusing on these patients, much of the available
work on the pathophysiology of weaning failure and ventilator manage¬
ment comes from the acute care setting. The trend toward the concentra¬
tion of patients into specialized regional weaning centers should facilitate
the research process and continue to improve outcomes in this population.
Noninvasive Mechanical Ventilation for Post Acute Care 35
Nicholas Hill
Noninvasive positive pressure ventilation has seen increasing use in the
management of both acute and chronic respiratory failure. Typical applica¬
tions in the post acute arena include weaning from noninvasive ventilation
of patients started for acute respiratory failure in the acute setting, facilita¬
tion of weaning from invasive mechanical ventilation by permitting early
extubation or therapy of extubation failure, and initiation of noninvasive
CLINICS IN CHEST MEDICINE
VOLUME 22 • NUMBER 1 • MARCH 2001 vii
ventilation in patients with chronic respiratory failure. The selection of
appropriate recipients of noninvasive ventilation is discussed, and tech¬
niques of application relevant to the post acute setting are reviewed.
Tracheostomy Management in the Chronically Ventilated
Patient 55
John E. Heffner and Dean Hess
Successful management of patients who require long term ventilatory sup¬
port requires a skilled approach to airway care. Tracheostomy provides
multiple benefits to patient care in addition to provision of airway access
for mechanical ventilation. Realization of these benefits, however, depends
on knowledge of approaches for promoting speech and nutrition in the
intubated patient, providing expert respiratory care, and initiating effective
weaning and airway decannulation efforts.
Respiratory Infection in the Chronically Critically 111 Patient:
Ventilator Associated Pneumonia and Tracheobronchitis 71
Qanta A. A. Ahmed and Michael S. Niederman
Nosocomial pneumonia and tracheobronchitis are common in mechani¬
cally ventilated patients, but the chronically ventilated patient presents
unique management problems. Although many chronically ventilated pa¬
tients develop pneumonia, the daily risk is lower than for short term
ventilated patients, reflecting a survivor effect and an inherently better
ability to resist infection compared with the acutely ill ventilated patient.
Chronically ventilated patients have many reservoirs for exposure to large
numbers of bacteria, including respiratory therapy devices and the hospi¬
tal environment. Exposure to bacteria can lead to tracheobronchial coloni¬
zation with gram negative bacteria, a common harbinger of pneumonia.
Colonization does not always lead to infection, especially if host defenses
are adequate. Colonization may be eliminated when host defenses im¬
prove, as can occur with nutritional support. Respiratory infection can
involve highly resistant bacteria, and therapy must be prompt and accu¬
rate. For organisms that are resistant to available antibiotics, adjunctive
inhaled antibiotics may be beneficial.
Antomicrobial Resistance in the Chronically Critically 111
Patient 87
Debra D. Poutsiaka
Infection caused by organisms resistant to conventional antimicrobial ther¬
apy is an emerging problem of global proportions. This article describes
the epidemiology of infections caused by resistant organisms in chronically
critically ill patients and explores factors and mechanisms that lead to
the development of resistance. Specific organisms and strategies for the
treatment and control of these resistance organisms are discussed.
Management of Venous Thromboembolic Disease in the
Chronically Critically 111 Patient 105
Maged A. Tanios, Amy R. Simon, and Paul M. Hassoun
The diagnosis of venous thromboembolism (VTE) is particularly challeng¬
ing in the mechanically ventilated patient in the post acute phase of an
illness because of the frequency of associated complex medical or surgical
illnesses. Although specific epidemiologic data are currently lacking, the
prevalence of VTE is probably high and may account for a large percentage
of hospital deaths in the group. This article reviews the general approach
ii contents
and the particular aspects to the diagnosis, management, and prevention
of VTE relative to this group of patients.
The Evaluation and Management of Hypoxemia in the Chronic
Critically 111 Patient 123
Alexander C. White
Hypoxemia is a prevalent problem in the chronically critically ill patient.
This article reviews the pathophysiologic mechanisms of hypoxemia in this
patient population, discusses how oxygenation is evaluated, and reviews
methods for delivery of oxygen. Other topics directly related to oxygen
use, such as oxygen toxicity heliox use, and portable oxygen devices, are
included.
Gastrointestinal Problems in the Chronically Critically 111
Patient 135
Sunil G. Sheth and J. Thomas LaMont
Gastrointestinal complications are common in chronically critically ill me¬
chanically ventilated patients. These complications are usually a conse¬
quence of the multiorgan failure that is prevalent in these patients. One of
the major gastrointestinal events that occurs in critically ill patients is
stress ulceration and hemorrhage. This can be easily prevented in most
patients by prophylactic H2 blockers. Other gastrointestinal complications
include infectious and noninfectious diarrhea, colonic ileus, acute mesen
teric ischemia, ischemic colitis, acalculous cholecystitis, ischemic hepatitis,
and pancreatitis. The clinical presentations in most patients are frequently
nonspecific and therefore require a high index of suspicion to decrease
morbidity and mortality.
Nutrition in Chronic Critical Illness 149
Susan K. Pingleton
Nutrition in chronic critical illness is essential to ensure the restoration of
muscle strength and immune status, both of which are necessary to attain
optimal patient function and survival. This article discusses nutritional
pathophysiology, goals, and support in patients with respiratory failure as
a model of nutritional management in chronically critically ill patients.
Nutritional assessment, methods of nutrient delivery, monitoring of nutri¬
tional therapy, and complications of nutritional support are discussed.
Acute Renal Failure and Dialysis in the Chronically Critically
111 Patient 165
Ali Al Khafaji and Howard L. Corwin
Acute renal failure is a common clinical problem in the intensive care unit
(ICU) and is associated with significant morbidity and mortality. There is
no magic bullet to prevent acute renal failure or to modify the clinical
course of established renal failure. The approach to therapy is directed to
the early initiation of dialysis therapy. Continuous dialysis therapy is
becoming the preferred form of dialysis in the ICU.
Cardiologic Problems in the Post Acute Ventilated Patient 175
Mary Seidlitz, George Madera, and John J. Smith
Cardiologic problems are common in the intensive care unit, often compli¬
cating the treatment of patients with respiratory failure. Often, decisions
CONTENTS ix
affecting these critically ill patients must be made at the bedside, before a
cardiology consultant can be engaged in the care. Effective management
of the critical care patient requires that the physician and nursing staff be
cognizant of the common cardiac problems, move quickly through the
differential diagnosis, and initiate effective treatment before there is further
clinical deterioration.
Endocrine Problems in the Chronically Critically 111 Patient 193
Falguni R. Vasa and Mark E. Molitch
Adaptations to critical illness result in several commonly encountered
clinical scenarios in patients with and without underlying endocrine condi¬
tions. These situations often pose diagnostic and therapeutic challenges
for the clinician. This article discusses the etiology, manifestations, evalua¬
tion, and treatment of hyperglycemia, alterations in thyroid homeostasis,
disorders of calcium balance, adrenal insufficiency, and hyponatremia.
Ethical Issues in the Chronically Critically 111 Patient 209
Jennifer M. Papa Kanaan and Leonard Sicilian
The chronically critically ill are a growing population of patients with
unique medical and ethical problems. Despite aggressive and high technol¬
ogy care used to treat these patients, their outcomes seem to be poor.
Understanding decision making in the face of this conflict requires knowl¬
edge of ethical principles that influence the thought process of the physi¬
cian and patient. The principles of autonomy, justice, and futility are
central to decision making in the chronically critically ill. Although there
is much to learn about this population, the physician can provide essential
direction to the patient in the process of making difficult decisions.
Index 219
Subscription Information Inside back cover
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| physical | XIV, 223 S. Ill., graph. Darst. |
| publishDate | 2001 |
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| series | Clinics in chest medicine |
| series2 | Clinics in chest medicine |
| spelling | Prolonged critical illness management of long-term acute care Alexander C. White ... guest ed. Philadelphia [u.a.] Saunders 2001 XIV, 223 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 22,1 Chronisch zieken gtt Intensive care gtt Maaladie grave Maladie chronique Soins longue durée Chronic Disease Chronically ill Care Critical Care Critical Illness Long-Term Care White, Alexander C. Sonstige oth Clinics in chest medicine 22,1 (DE-604)BV000001084 22,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009369303&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Prolonged critical illness management of long-term acute care Clinics in chest medicine Chronisch zieken gtt Intensive care gtt Maaladie grave Maladie chronique Soins longue durée Chronic Disease Chronically ill Care Critical Care Critical Illness Long-Term Care |
| title | Prolonged critical illness management of long-term acute care |
| title_auth | Prolonged critical illness management of long-term acute care |
| title_exact_search | Prolonged critical illness management of long-term acute care |
| title_full | Prolonged critical illness management of long-term acute care Alexander C. White ... guest ed. |
| title_fullStr | Prolonged critical illness management of long-term acute care Alexander C. White ... guest ed. |
| title_full_unstemmed | Prolonged critical illness management of long-term acute care Alexander C. White ... guest ed. |
| title_short | Prolonged critical illness |
| title_sort | prolonged critical illness management of long term acute care |
| title_sub | management of long-term acute care |
| topic | Chronisch zieken gtt Intensive care gtt Maaladie grave Maladie chronique Soins longue durée Chronic Disease Chronically ill Care Critical Care Critical Illness Long-Term Care |
| topic_facet | Chronisch zieken Intensive care Maaladie grave Maladie chronique Soins longue durée Chronic Disease Chronically ill Care Critical Care Critical Illness Long-Term Care |
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