Recognition, assessment, and treatment of anxiety in the critical care patient.

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Life and near-death in the intensive care unit. A personal experience.

Being seriously ill, even once, is an experience from which one learns a great deal. To feel the loss of control, the pain, and the worry about unfulfilled responsibilities at home and at work forever provides one with the motivation to deal with these issues when confronted with sick people. To understand that each illness has unique effects on a patient and that these patients almost always trust us, gives us the confidence to use our training and experience to do what we know is right for them. We should be confident that if these lessons are internalized and applied, patients and their caretakers will benefit.

Haemophilus influenzae type B impairment of pial vessel autoregulation in rats.

To examine the mechanisms of autoregulatory impairment in meningitis, we studied the effects of Haemophilus influenzae type b (Hib) on pial vessels during hemorrhagic hypotension in rats, using a cranial window technique. We prepared cranial windows in barbiturate-anesthetized, mechanically ventilated rats. Artificial cerebrospinal fluid or 10(5) Hib in cerebrospinal fluid (n = 7 each group) was suffused over the pial surface. Pial arteriolar diameter was measured hourly for 4 h. Autoregulation was assessed as the ability of pial arterioles to dilate in response to graded hemorrhagic hypotension at 2 and 4 h. Pial arterioles exposed to Hib dilated progressively to 149 +/- 27% of baseline at 4 h. Vessel diameter in the Hib group was significantly greater than in the control group beginning at 2 h. Autoregulation was progressively impaired in Hib-exposed rats compared with control rats [-5.85 +/- 1.38 versus -8.02 +/- 2.02 and -3.82 +/- 1.57 versus -8.53 +/- 1.72% dilation/kPa fall in mean arterial blood pressure at 2 and 4 h, respectively (p < 0.05)]. These data suggest that autoregulation is impaired in pial arterioles exposed to Hib because involved vessels have a finite dilatory capacity and are close to maximal dilation before hypotensive challenge.