Chronic critical illness:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | Critical care clinics
18,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 462 - 728 |
Internformat
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| 245 | 1 | 0 | |a Chronic critical illness |c David M. Nierman, guest ed. |
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| 650 | 7 | |a Chronische ziekten |2 gtt | |
| 650 | 7 | |a Intensive care |2 gtt | |
| 650 | 4 | |a Catastrophic illness | |
| 650 | 4 | |a Chronic Disease | |
| 650 | 4 | |a Chronic diseases | |
| 650 | 4 | |a Critical Care | |
| 650 | 4 | |a Critical Illness | |
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Datensatz im Suchindex
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| adam_text | f I IRONIC CRI nCAL lLf .NESS
CONTENTS
Preface xi
David M. Nierman and Judith E. Nelson
The Epidemiology and Costs of Chronic Critical Illness 461
Shannon S. Carson and Peter B. Bach
Chronically critically ill (CCI) patients have been gaining
increasing attention from healthcare providers and adminis¬
trators due to their intense medical needs and disproportionate
consumption of resources. Innovative attempts to address their
medical needs within the constraints of available resources have
led to important changes in patient management and healthcare
delivery. This article describes CCI patients in terms of demo¬
graphics, diagnoses, and risk factors using studies in the litera¬
ture and original data. Outcomes for CCI are reviewed including
survival, functional status, quality of life, and costs of care.
A Structure of Care for the Chronically Critically 111 477
David M. Nierman
The chronically critically ill (CCI) are complicated, labor intensive,
and costly patients to care for. A defined structure of care with dif¬
ferent focuses at the beginning, middle, and end of a care episode
may improve their outcomes and resource utilization. This article
reviews the prediction of CCI, outlines some unifying processes of
care during an episode of chronic critical illness, and explores
some of the difficulties in defining consistent goals of care for this
patient population.
Nursing the Chronically Critically 111 Patient 493
Miriam Carasa and Grace Nespoli
The chronically critically ill (CCI) population has complex and
unique nursing needs. To meet the needs of both CCI patients and
VOLUME 18 • NUMBER 3 • JULY 2002 v
health care professionals who care for them, innovative care
models have been developed as alternatives to the traditional
ICU model. One such model is the Respiratory Care Unit (RCU)
at Mount Sinai Hospital, in which nurse practitioners (NPs)
work with clinical nurses and a clinical nurse manager to provide
intensive and comprehensive care to CCI patients. In this model,
NPs successfully coordinate medical and nursing care in collab¬
oration with physicians, social workers, physical therapists, and
clinical nurses. This interdisciplinary approach is central to the
successful provision of competent and compassionate care to the
CCI patient. While the RCU is one successful nurse leadership
model of caring for CCI patients, diverse hospitals and health
systems can adopt some aspects of the model to accommodate
their needs and resources.
Neuroendocrine Pathobiology of Chronic Critical Illness 509
Greet Van den Berghe
The importance of an intact hypothalamus pituitary axis for
metabolic and immunological homeostasis during stress is well
recognized. Mostly by extrapolation, the neuroendocrine changes
in chronic critical illness were assumed to be identical to those
observed in models of acute stress such as surgery, trauma, acute
infection. This assumption has now been invalidated. It recently
became clear that hypothalamus anterior pituitary function is
altered differently in the acute phase and the chronic of critical
illness and a neuroendocrine dysfunction was observed to
partially explain several metabolic problems present in chronic
critical illness. The novel insights will be reviewed in this chapter.
Infection in the Chronically Critically 111: Unique Risk
Profile in a Newly Defined Population 529
Thomas H. Kalb and Scott Lorin
Although chronic critical illness (CCI) is defined as prolonged
ventilatory failure with tracheotomy stemming from preceding
critical illness, the contention that multisystem debilities impact on
most CCI patients care and recovery is a central thesis of this
volume. Perhaps reflecting the combined debilities inherent
in CCI, infectious complications take their toll in morbidity,
mortality and persistent ventilatory insufficiency. Enhanced
susceptibility to infection results from a potent admixture of barrier
breakdown, exposure to virulent and resistant nosocomial
pathogens, and postulated immune exhaustion that stems from
the combined impact of comorbidities and the sequellae of critical
illness. Strategies to improve outcome in CCI related infection
include standard measures of support especially nutrition, reduc¬
ing environmental inoculum through pulmonary hygiene mea¬
sures, skin care and limiting barrier breaches, and appropriate
antimicrobials directed at likely pathogens. Future stratification of
vi CONTENTS
patient risk on the basis of immune phenotype or genotype and
potential immunomodulatory prophylaxis may be around the
corner, as new prospects in the pharmaceutical armamentarium are
presently undergoing testing.
Critical Illness Neuromuscular Abnormalities 553
Scott Lorin and David M. Merman
The chronically critically ill (CCI) are a group of intensive care unit
(ICU) patients who require long term mechanical ventilation.
Many acutely critically ill patients develop new neuromuscular
disorders following ICU admission secondary to their critical
illness. These acquired disorders have been labeled Critical Illness
Neuromuscular Abnormalities (CINMAs). Critical Illness
Polyneuropathy (CIP) has been the most widely studied CINMA.
CINMAs can lead to ventilator dependency and contribute to
the development of chronic critical illness. This chapter will review
the epidemiology, etiology, treatment, and prognosis of patients
with CINMAs.
Liberation from Prolonged Mechanical Ventilation 569
David J. Scheinhorn, David C. Chao, and
Meg Stearn Hassenpflug
After weaning from prolonged mechanical ventilation (PMV),
patients are usually far from ready to resume normal activities. A
prolonged recovery period after catastrophic illness is the rule,
with multidisciplinary rehabilitation and discharge planning
efforts. Following such efforts, reports of success of restorative care
are institutional and population specific. That all PMV patients are
not chronically critically ill introduces selection factors that make
comparisons between institutions even more difficult. Results of
functional status studies and quality of life (QQL) measures, some
using validated instruments, are now being reported in small series
of PMV patients. These will merit consideration as important as
weaning outcome, disposition, and survival data, as they accumu¬
late to round out the treatment results in this population. Those
who work to liberate PMV patients from mechanical ventilation
have demonstrated that this post ICU critical care activity is usually
safe, and successful, although only in observational studies. Will
multicenter studies in PMV patients liberated from mechanical
ventilation yield facility benchmark, weaning outcome, and
survival data that warrant continuation of these activities on a
cost per outcome basis? That remains to be seen. Assessing and
interpreting QOL and functionality findings in these patients,
many with underlying chronic diseases resulting in long conva¬
lescence and rehabilitation, is a particularly important challenge.
CONTENTS vii
Nutrition Support of the Chronically Critically 111 Patient 597
Jeffrey I. Mechanick and Elise M. Brett
Chronically critically ill patients develop adult kwashiorkor like
malnutrition, metabolic bone disease, hypothalamic pituitary
dysfunction, and various micronutrient deficiencies. Guidelines
are provided regarding the use of enteral and parenteral nutrition,
as well as various dietary supplements, anabolic/anticatabolic
agents, and appetite stimulants. Strategies for the management of
diarrhea and wound healing, and malnutrition in the obese patient
are also discussed.
Endocrine and Metabolic Issues in the Management of the
Chronically Critically 111 Patient 619
Jeffrey I. Mechanick and Elise M. Brett
The metabolic syndrome of chronic critical illness (CCI) consists of
multisystem organ dysfunction resulting from the initial acute
injury and chronic immune neuroendocrine axis activation, adult
kwashiorkor like malnutrition, and prolonged immobilization
with suppression of the PTH vitamin D axis and hyperresorptive
metabolic bone disease. CCI patients can also present unique
challenges in the management of diabetes mellitus, thyroid and
adrenal diseases, electrolyte abnormalities and hypogonadism.
Multidisciplinary Care of the Obese Patient with Chronic
Critical Illness After Surgery 643
Stanley A. Nasraway, Jr, Therese M. Hudson Jinks, and
Ruth M. Kelleher
The critically ill surgical patient who enters into a chronic phase of
illness and subsequent recovery resembles the chronically critically
ill medical patient. There are some differences, however, related to
wound management and underlying surgical issues that led to
intensive care unit (ICU) admission. Like medical patients with
chronic critical illness (CCI), the surgical patient population has
poor ICU, hospital, and extended care facility survival, and
consumes a staggeringly disproportionate share of resources in
each setting. This article will focus on special issues for the obese
surgical patient with CCI.
Palliative Care of the Chronically Critically 111 Patient 659
Judith E. Nelson
Evidence is accumulating that distressing physical and emotional
symptoms are prevalent among patients with critical illness,
including those requiring prolonged mechanical ventilation, and
that suffering is underestimated and undertreated by caregivers.
Although patients and their families rank communication as a
viii CONTENTS
preeminent concern, it remains deficient in process and content,
even when the illness requires weeks of critical care. Strategies are
available to improve symptom management and communication
about appropriate goals of care. For the chronically critically ill,
whose risks of death, disability, and suffering are so high, it is
essential that excellent palliative care be provided along with
restorative treatment in an integrated way.
Pressure Ulcers in the Chronically Critically 111 Patient 683
Harold Brem, David M. Nierman, and Judith E. Nelson
All chronically critically ill patients are at high risk for develop¬
ment and progression of pressure ulcers. Constant surveillance
including daily examination of the skin must be part of the care
protocol. All pressure ulcers are chronic wounds that have an
inherent, physiologic impairment to healing. As soon as a pressure
ulcer develops, intervention should begin immediately, and a
treatment plan should be determined. We believe that early inter¬
vention and appropriate treatment, guided by the paradigm we
have described, can retard progression and promote healing.
Treatment decisions should be made within the context of the
patient s overall care goals.
Rehabilitation of the Patient with Chronic Critical Illness 695
David C. Thomas, Isaac J. Kreizman, Philip Melchiorre,
and Kristjan T. Ragnarsson
Patients with chronic critical illness (CCI) have continuing
profound medical needs, poor prognosis for significant functional
recovery and a high mortality rate. Nonetheless, some survive for
months or years, but unfortunately often with functional skills and
quality of life lower than need be. Careful evaluation of each
patient s medical condition and potential for functional improve¬
ment, early involvement of the rehabilitation team, prevention and
treatment of medical conditions associated with prolonged bedrest
and immobility, reduction of the emotional and financial burden of
family members and establishment of reasonable goals can
increase self sufficiency and quality of life regardless of discharge
destination.
Index 717
CONTENTS ix
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| spelling | Chronic critical illness David M. Nierman, guest ed. Philadelphia [u.a.] Saunders 2002 XII S., S. 462 - 728 txt rdacontent n rdamedia nc rdacarrier Critical care clinics 18,3 Chronische ziekten gtt Intensive care gtt Catastrophic illness Chronic Disease Chronic diseases Critical Care Critical Illness Critical care medicine Chronisch Kranker (DE-588)4010173-3 gnd rswk-swf Intensivmedizin (DE-588)4027263-1 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Chronisch Kranker (DE-588)4010173-3 s Intensivmedizin (DE-588)4027263-1 s DE-604 Nierman, David M. Sonstige oth Critical care clinics 18,3 (DE-604)BV000019838 18,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009941787&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Chronic critical illness Critical care clinics Chronische ziekten gtt Intensive care gtt Catastrophic illness Chronic Disease Chronic diseases Critical Care Critical Illness Critical care medicine Chronisch Kranker (DE-588)4010173-3 gnd Intensivmedizin (DE-588)4027263-1 gnd |
| subject_GND | (DE-588)4010173-3 (DE-588)4027263-1 (DE-588)4143413-4 |
| title | Chronic critical illness |
| title_auth | Chronic critical illness |
| title_exact_search | Chronic critical illness |
| title_full | Chronic critical illness David M. Nierman, guest ed. |
| title_fullStr | Chronic critical illness David M. Nierman, guest ed. |
| title_full_unstemmed | Chronic critical illness David M. Nierman, guest ed. |
| title_short | Chronic critical illness |
| title_sort | chronic critical illness |
| topic | Chronische ziekten gtt Intensive care gtt Catastrophic illness Chronic Disease Chronic diseases Critical Care Critical Illness Critical care medicine Chronisch Kranker (DE-588)4010173-3 gnd Intensivmedizin (DE-588)4027263-1 gnd |
| topic_facet | Chronische ziekten Intensive care Catastrophic illness Chronic Disease Chronic diseases Critical Care Critical Illness Critical care medicine Chronisch Kranker Intensivmedizin Aufsatzsammlung |
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