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If we’ve learned one thing about hospital care in recent years it’s this -- being a patient can be more dangerous than whatever medical problems you already had! It’s one of those perplexing ironies, but the intensive care unit (ICU), in particular, can be destructive to one’s health and well-being. As many as 80% of patients who have survived a critical illness that required a stay in intensive care paid a price. While recovering from the immediate problem -- such as a heart attack or pneumonia -- many patients develop cognitive problems, for example, trouble with focus and concentration. They may also have difficulty performing simple, everyday tasks and experience a decreased quality of life, and once they’ve left the hospital, they may find themselves unable to return to work. In some cases, individuals continue to feel these ill effects up to one or two years later... and for an unlucky few, the impact is even longer term.
Memory and thinking difficulties after a stay in the ICU can make it seem as if your brain is stuck in molasses, observes E. Wesley Ely, MD, MPH, an expert in critical care at Vanderbilt University School of Medicine. Now he and his colleagues have designed a five-step protocol to improve care and outcomes for ICU patients. Since
Daily Health News has reported on some of these proposed innovations in the past (
Daily Health News,
December 7, 2010), I’m glad to see that they actually are being put into practice.
The Code: A-B-C-D-E
At Vanderbilt, Dr. Ely and his colleagues have devised what they call the A-B-C-D-E model of care:
- Awakening (stopping sedation)
- Breathing Coordination (stopping respirator)
- Choice of Proper Sedation
- Delirium Monitoring
- Early Exercise and Mobility
Some four out of every 10 US hospitals have already introduced at least some of these steps, but the guidelines are basic enough that family members can check to see if they’re being followed. (Note: This is a key reason why it is so important to stay with a loved one during a hospitalization.)
Your Role in the Hospital
Here is what you can do to make sure that caregivers know their A,B,C,D,Es and that you or your loved one gets the best possible care in the ICU...
Wake Patients at Regular Intervals
Many hospitals now make it a habit to wake sedated patients and those on ventilators to see whether they can breathe on their own -- the idea being that the earlier that breathing tubes and ventilators can be removed, the lower the risk for delirium and subsequent cognitive difficulties. But the flip side of this guideline may be equally important -- hospitals should let patients sleep through the night whenever possible! As many of us know from personal experience, sleep is often the casualty of a hospital stay. Caregivers should wake patients a few times a day, and if they’re sleeping through the night, leave them be.
Go Light on the Sedation
Like sleep deprivation, heavy and prolonged sedation can cause or worsen delirium. Some sedatives (such as benzodiazepines) are more likely than others to produce delirium, but Dr. Ely emphasizes that sedation is not a one-size-fits-all proposition and must be carefully individualized. A good approach, Dr. Ely says, is to ask your physician to use the lightest possible postsurgical sedation -- a level that effectively relieves pain but still leaves the patient’s mental state as intact as possible.
Get Out of Bed
Most ICU patients should move around as much as possible because we now know that immobility leads not only to loss of muscle strength and increased frailty, but also a higher risk for confusion and delirium. ICU patients can often receive physical therapy that helps them stay limber with range-of-motion exercises. When patients are able, it’s good for them to leave the bed and sit in a chair (with help of course) a few times a day and eventually work their way up to a walk down the hall.
Watch Carefully for Signs of Delirium
It’s vital to make sure that the doctors and nurses are watching for signs of delirium (and loved ones and family members should also be closely attuned for telltale signs) because the longer delirium persists in the ICU, the greater the likelihood of later cognitive impairment.
To catch delirium early on, doctors and nurses (and you, too) need to check patients for such early signs as inattentiveness -- for instance, the inability to stay focused or follow a command for 10 seconds (such as being able to squeeze the nurse’s hand every time she says a word with the letter "A" in it). If confused responses suggest delirium, your physician can take prompt steps to control it, including cutting back on sedatives... helping the patient to get out of bed and move around (with appropriate assistance)... removing physical restraints and catheters... and allowing him/her to sleep through the night by performing only nonintrusive monitoring of vital signs.
If You See Something, Say Something
ICU patients are very sick, typically not well enough to advocate for themselves, which means it’s up to family members and close friends to step in and fill the breach. Dr. Ely advises that you do this by keeping in very close touch with the patient’s medical team. If you notice, for example, that your mother suddenly seems "not herself" -- even if there are no obvious signs of delirium -- tell her physician right away and bring up the possibility of early delirium. Dr. Ely says that alerting doctors is half the battle and can unquestionably lead to better, happier outcomes all around. The new model, he hopes, will make ICU care much easier -- almost as simple as knowing your A,B,C,D,Es!
Source(s):
E. Wesley Ely, MD, MPH, professor of medicine, Vanderbilt University School of Medicine, Nashville. He is founder of Vanderbilt’s ICU Delirium and Cognitive Impairment Study Group and the associate director of aging research for the VA Tennessee Valley Geriatric Research and Education Clinical Center (GRECC).
Erase Tumors in 2 Months
"Within two months, every tumor had shrunk, dried up and fallen off," said Tom to Dr. Gary Null about the miraculous disappearance of his rapidly spreading cancer.
Tom had already gone through surgery once for skin cancer on his forehead. Unfortunately, his skin cancer was melanoma. Just 10 days after the operation, the cancer was back with a vengeance. It reappeared on his forehead, and quickly spread to his arm, upper body and chest.
Four doctors all agreed: There was nothing they could do to cure this cancer. They all still wanted to operate. But Tom wanted to live -- not just get sliced up.
Read on to learn what Tom did to save his life...
Kudzu Root Tames Alcohol Drive
Way back in 1876, to combat soil erosion in the southeastern US, scientists here imported a Japanese climbing vine that would spread faster (one foot per day!) than anything we already had. As many of us have seen firsthand all these years later, this may not have been a good plant to bring to our country... in fact, kudzu is so aggressive and fast-growing that the US government declared it a "noxious weed" in 1997 because the unstoppable vine has been engulfing and destroying trees and other vegetation across swaths of the country. It has even been known to engulf houses!
But in matters of health, it turns out that kudzu may be a real boon. The latest discovery: It has a novel ability to help people who drink too much.
The idea that kudzu has health benefits isn’t new -- practitioners of Eastern medicine have a wealth of uses for kudzu root powder, including as a tea to treat such conditions as tinnitus and vertigo, diabetes and metabolic syndrome. It’s true that when it comes to drinking too much alcohol, it’s best to "just say no" -- but at Harvard’s McLean Hospital, researchers have been studying whether kudzu can help quell the urge in people more apt to say yes. They’ve now confirmed that it can.
A Party for Study Participants
Study author David M. Penetar, PhD, in McLean’s Behavioral Psychopharmacology Research Laboratory, told me that 14 male and female volunteers in their 20s who, according to their own reports, regularly had three or four alcoholic drinks per day but had no family history of alcoholism were given either kudzu extract or a placebo for nine days. At the end of the nine days, they were invited to sit in a laboratory setup "apartment" -- with a sofa, TV and beer-stocked fridge -- where they could hang out, watch television and drink as much as they wanted. There was a specially designed table where they rested their beer mugs (between quaffs), equipped with a built-in scale that measured how much beer was swallowed each time a person picked up a mug to take a sip (or gulp, as the case may be).
Meanwhile researchers also took blood samples to measure each person’s chemical response to alcohol. Interestingly, they found that the concentrations of blood alcohol climbed slightly faster in the group that had been taking kudzu, but their peak blood alcohol levels climbed no higher than peak levels in the placebo group when compared with those who had consumed an equal amount of alcohol. In other words, kudzu sped up but did not strengthen the alcohol’s effect. Researchers believe this was because kudzu contains several isoflavones, in particular diadzin, diadzein and puerarin, which are known to decrease ability to absorb ethanol (alcohol).
Whatever the cause, it seemed that taking kudzu reduced the desire for alcohol, resulting in a significant decrease in how much the study participants actually drank, with the kudzu group averaging 1.8 beers per session while those in the placebo group drank on average 3.5 beers. Dr. Penetar told me that taking kudzu did not get participants more drunk or less drunk -- they know this because they measured how the same amount of alcohol impacted body stance and vigilance/reaction time. He said that the kudzu-takers reported feeling the effects of the beer sooner than they would have without kudzu.
Drink to That?
Based on the study findings, Dr. Penetar says that people who tend to drink too much may want to consider taking kudzu root in order to reduce their alcohol consumption. Study volunteers took two 500-mg capsules with meals three times a day for a daily total of three grams per day. Kudzu capsules are available in health-food stores, but none of the products currently on the market has an active ingredient level of the isolated target compounds of 25% -- 19% puerarin, 4% diadzin, 2% diadzein -- which is the formulation used in the study. The McLean research team is working with a lab to formulate such a capsule and hopes to bring it to market in a year or so.
Dr. Penetar told me that researchers are currently trying to learn whether taking kudzu immediately before drinking will help curb the desire for alcohol, but he explained that people who suffer from alcoholism will need more than just an extract of kudzu. "They need to go through normal medical detox, but after that, taking kudzu might help them if they have a relapse," he said, adding that alcoholics would probably need to take kudzu every day to achieve the constant and protective level that would best serve them.
Source(s):
David M. Penetar, PhD, assistant professor of psychology, department of psychiatry, Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, Belmont, Massachusetts.
Be well,
Carole Jackson
Bottom Line's Daily Health News
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