MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Critical Care Clinics' source. Thu, 09 Feb 2012 10:59:50 +0100 http://www.medworm.com/index.php?rid=5453308&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411001023%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453308 Tue, 29 Nov 2011 04:36:52 +0100 5453308 http://www.medworm.com/index.php?rid=5453307&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100073X%2Fabstract%3Frss%3Dyes Formal health economics and health technology assessment (HTA) processes, including cost-effectiveness and cost-utility analysis, are variably used to inform decisions about public and private health service funding and service provision. In general, pharmaceuticals have been subject to more sophisticated health economic analyses and HTAs and for a longer time than either devices or procedures. HTA has been performed by a number of different entities including agencies located within various government departments, private sector agencies, and academic and professional groups. While HTA shares many common features across the world, its uses, approaches, applications, and impact differ throughout the world. This chapter will discuss some of the general attributes of HTA and will focus on it... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453307 Tue, 29 Nov 2011 04:36:52 +0100 5453307 http://www.medworm.com/index.php?rid=5453305&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000716%2Fabstract%3Frss%3Dyes The kidney is an organ of opportunity cost in the sense that its function is often sacrificed in exchange for the preservation of function of another organ, organ system, or multiorgan process. This occurs either as a result of a physiologic internal compensatory mechanism or from an iatrogenic insult. Physiologic examples include sepsis, congestive heart failure, and volume depletion, in which the development of acute renal failure (ARF) serves as a signal to the physician, via a reduction in urine output or a rise in serum creatinine, that another process is at play resulting in kidney dysfunction. Physicians weigh risks and make decisions to administer nephrotoxic antibiotics (polymyxin, aminoglycosides) or contrast material, knowing that this may result in kidney dysfunction. Fluid man... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453305 Tue, 29 Nov 2011 04:36:52 +0100 5453305 http://www.medworm.com/index.php?rid=5453304&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000704%2Fabstract%3Frss%3Dyes In response to the Institute's of Medicine 1999 report “To err is human,” policymakers, payers, and physicians have placed substantial emphasis on the prevention of nosocomial complications. Shocked by the sheer magnitude of preventable morbidity and mortality, a concerted effort has begun to change the way health care is delivered. With renewed vigor, the quality improvement (QI) movement has grown exponentially in recent years, as evidenced by a sharp rise in both research dollars directed at QI and the influence of organizations and initiatives addressing QI. With the knowledge that health care–associated infections (HAIs) occur in an estimated 1.7 million cases annually in the United States, cause 99,000 deaths, and cost between $28 and $33 billion, inaction was not an option. (S... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453304 Tue, 29 Nov 2011 04:36:52 +0100 5453304 http://www.medworm.com/index.php?rid=5453303&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000728%2Fabstract%3Frss%3Dyes Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for more than 17% of total health expenditures. As such, the clinical and economic implications of this disease are enormous. A variety of medical treatments and technologies have been developed to manage CVD more effectively, improving patient longevity and quality of life. Yet in an increasingly cost-conscious economic environment, it is important to understand not only the effectiveness of these alternative treatments and technologies but also their cost-effectiveness. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453303 Tue, 29 Nov 2011 04:36:52 +0100 5453303 http://www.medworm.com/index.php?rid=5453302&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000601%2Fabstract%3Frss%3Dyes Sepsis, severe sepsis, and the systemic inflammatory response syndrome (SIRS) are among the most common reasons for admission to the intensive care unit (ICU). The global epidemiologic burden of sepsis is increasing for a variety of reasons, chief among them the aging population of developed countries. The financial burden of sepsis is also growing, due both to increasing fixed costs and to the development of expensive new drugs and technologies. Together these two phenomena lead to a significant economic impact that contributes to increasing strain on national and international health care resources. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453302 Tue, 29 Nov 2011 04:36:52 +0100 5453302 http://www.medworm.com/index.php?rid=5453301&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000698%2Fabstract%3Frss%3Dyes Acute respiratory failure is a common and life-threatening consequence of a diverse group of diseases, including those that cause a failure of gas exchange, a failure of airway protection mechanisms, or the need for temporary respiratory support after general anesthesia. For patients who have acute respiratory failure, mechanical ventilation (MV) provides the most common, definitive, and potentially life-saving therapy. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453301 Tue, 29 Nov 2011 04:36:52 +0100 5453301 http://www.medworm.com/index.php?rid=5453299&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000674%2Fabstract%3Frss%3Dyes Resources in the health care system are limited, and it is important to maximize the health benefits to patients within the resources available. In the critical care setting, this is becoming increasingly important as the demand for services grows and the costs associated with treatment increase. In the United States, intensive care units (ICUs) consume more than 20% of total hospital costs despite accounting for only 10% of hospital beds. As a result, economic evaluations are becoming increasingly important in guiding decision making in the critical care setting. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453299 Tue, 29 Nov 2011 04:36:52 +0100 5453299 http://www.medworm.com/index.php?rid=5453298&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000686%2Fabstract%3Frss%3Dyes “By a wide margin the biggest threat to our nation's balance sheet is the skyrocketing cost of health care.” —President Barack Obama, March 2009 Health care in the United States is by far the most expensive in the world. In 2009, national health expenditures (NHE) in the United States were estimated to be $2.5 trillion accounting for 17.6% of the gross domestic product (GDP). Although landmark legislation and governmental programs have recently been passed and initiated with a focus toward cost control, the US patient care delivery system has been continuously evolving over the last 20 years. Acute care hospitals have closed, and inpatient care has shifted to the outpatient arena. Concomitantly, the number of critical care medicine (CCM) beds has steadily increased as hospitalized p... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453298 Tue, 29 Nov 2011 04:36:52 +0100 5453298 http://www.medworm.com/index.php?rid=5453297&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000923%2Fabstract%3Frss%3Dyes Health care has always had to grapple with limited resources, but the challenge that society increasingly faces today is how to continue to deliver high-quality care that yields meaningful outcomes in the face of ever-constrained budgets. Perhaps this missive is most imperative in the critical care setting, where costs are disproportionately high relative to other medical services, and outcomes are usually the most tenuous, uncertain, and unpredictable. Inherent in all this is the notion that health care decisions should never be a matter of cutting costs or assessing the financial ramifications of a particular endeavor, but rather, a matter of allocating scare resources toward those services, programs, and interventions that will provide the greatest overall benefit to those in need. The ... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453297 Tue, 29 Nov 2011 04:36:52 +0100 5453297 http://www.medworm.com/index.php?rid=5453296&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411001084%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453296 Tue, 29 Nov 2011 04:36:52 +0100 5453296 http://www.medworm.com/index.php?rid=5453295&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100100X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453295 Tue, 29 Nov 2011 04:36:52 +0100 5453295 http://www.medworm.com/index.php?rid=5453294&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000996%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453294 Tue, 29 Nov 2011 04:36:52 +0100 5453294 http://www.medworm.com/index.php?rid=5453300&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000613%2Fabstract%3Frss%3Dyes Intensive care is an integral but expensive component of healthcare in developed countries. An estimate in the United States is that fully 2% of the population receives intensive care every year, and overall the percentage of patients who receive intensive care before they die is increasing. Projections of the need for mechanical ventilation predict an exponential growth in the coming years due to the aging population and their over-representation among mechanically ventilated cohorts; this increase in need for mechanical ventilation will be associated with increasing costs of intensive care. Much of the focus of intensive care is on improvements in technology for organ support and resuscitation. Yet quality healthcare also involves appropriate organization of resources, with the potential... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453300 Mon, 24 Oct 2011 04:00:00 +0100 5453300 http://www.medworm.com/index.php?rid=5453306&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000625%2Fabstract%3Frss%3Dyes Venous thromboembolic (VTE) disease is associated with significant morbidity and mortality, particularly in critically ill patients. Preexisting impairments in both cardiac and pulmonary function limit the ability of these organs to compensate for an acute pulmonary embolus (PE). Risk factors associated with VTE vary depending on the reason for critical illness. For example, approximately 60% of patients admitted with a traumatic insult will develop a deep venous thrombosis (DVT) compared to 28% to 32% in the general medical-surgical intensive care unit (ICU) population. More concerning, the incidence of DVT is as high as 70% in acute stroke patients where 1% to 2% of patients with hemiplegia eventually succumb to a fatal PE. The clinical status of ICU patients adds to the challenge of dia... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5453306 Fri, 14 Oct 2011 04:00:00 +0100 5453306 http://www.medworm.com/index.php?rid=5415923&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000819%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415923 Sat, 01 Oct 2011 04:00:00 +0100 5415923 http://www.medworm.com/index.php?rid=5415922&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000650%2Fabstract%3Frss%3Dyes Acute venous thromboembolism remains a frequent disease, with an incidence that ranges between 23 and 69 cases per 100,000 population per year. Of these patients, approximately one-third present with clinical symptoms of acute pulmonary embolism (PE) and two-thirds with deep venous thrombosis (DVT). Unfortunately, morbidity and mortality associated with acute PE remain high despite the recent advances in noninvasive imaging modalities, notably computed tomographic pulmonary angiography, and of the highly effective therapeutic options currently available. Case fatality rates vary widely depending on the clinical severity of the thromboembolic episode, but large recent registries and cohort studies suggest that approximately 10% of all patients with acute PE die during the first 1 to 3 month... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415922 Sat, 01 Oct 2011 04:00:00 +0100 5415922 http://www.medworm.com/index.php?rid=5415921&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000649%2Fabstract%3Frss%3Dyes Arterial thrombosis and venous thrombosis are common problems facing clinicians. Some patients with thrombosis have an underlying hypercoagulable state. These states can be divided into 3 categories: inherited disorders, acquired disorders, and those that are mixed in origin. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415921 Sat, 01 Oct 2011 04:00:00 +0100 5415921 http://www.medworm.com/index.php?rid=5415920&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000637%2Fabstract%3Frss%3Dyes Pulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke. In 2006, 828,000 patients were hospitalized in short-stay non-Federal hospitals in the United States with acute myocardial infarction and 564,000 with stroke (F. Matta and P.D. Stein, unpublished data from the National Hospital Discharge Survey, 2010). In 2006, 247,000 adults were hospitalized with acute PE. The number and proportion of hospitalized patients with PE is increasing ( and ). As many as 25% may die before admission. Patients with acute PE in 2006 represented 0.77% of hospitalized patients 18 years of age or older, and 110 patients/100,000 adult population. In 2006, 467,000 patients were hospitalized with deep venous thrombosis (DVT). This represented 1.5% of ho... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415920 Sat, 01 Oct 2011 04:00:00 +0100 5415920 http://www.medworm.com/index.php?rid=5415919&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000595%2Fabstract%3Frss%3Dyes This article will review a structured pathophysiologic approach to the diagnostic, resuscitative and management strategies related to PE in the ICU. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415919 Sat, 01 Oct 2011 04:00:00 +0100 5415919 http://www.medworm.com/index.php?rid=5415918&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000583%2Fabstract%3Frss%3Dyes Venous thromboembolism (VTE), originates in systemic venous thrombosis, and has different etiological mechanisms and natural history from arterial thrombosis. VTE typically originates as deep venous thrombosis (DVT) in a lower extremity, where it may give rise to acute symptoms “upstream” from the obstructed vein, result in pulmonary embolism (PE) and/or cause chronic venous obstruction. PE may result in acute respiratory symptoms, cardiovascular collapse and, uncommonly, may also cause chronic disease. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415918 Sat, 01 Oct 2011 04:00:00 +0100 5415918 http://www.medworm.com/index.php?rid=5415917&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000571%2Fabstract%3Frss%3Dyes Estimates of the incidence and case-fatality rates of venous thromboembolism in the United States vary widely owing to limitations in the accuracy of clinical diagnosis and the dearth of autopsy data. Even the most conservative estimate, however, would suggest an incidence of 200,000 episodes of venous thromboembolism annually in the United States, resulting in approximately 30,000 to 50,000 deaths. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415917 Sat, 01 Oct 2011 04:00:00 +0100 5415917 http://www.medworm.com/index.php?rid=5415915&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000558%2Fabstract%3Frss%3Dyes Why should a Critical Care Clinics issue, “Venous Thromboembolism in the ICU,” include the topic, “Heparin-induced thrombocytopenia in critically ill patients”? First, there is increasing focus on the prevention of venous thromboembolism (VTE) in critically ill patients, most widely through use of heparin, either unfractionated or low molecular weight. Immune heparin-induced thrombocytopenia (HIT) represents one of the complications of such prophylaxis. Ironically, since HIT is strongly associated with thrombosis—particularly deep-vein thrombosis (DVT) and pulmonary embolism (PE)—VTE can result through the very effort to prevent its occurrence! Second, HIT can be the reason for admission into the intensive care unit (ICU), either because of life-threatening thrombosis, adrenal ... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415915 Sat, 01 Oct 2011 04:00:00 +0100 5415915 http://www.medworm.com/index.php?rid=5415914&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000546%2Fabstract%3Frss%3Dyes During the last decade, awareness over venous thromboembolic disease has risen markedly among health care professionals and the general public. The Surgical Care Improvement Project (SCIP) includes institution of venous thromboembolic prophylaxis within 24 hours of anesthesia end time as a core measure. In 2008, the Joint Commission, National Quality Forum, and Centers for Medicare & Medicaid Services approved six inpatient quality measures. VTE-2 assesses the use of venous thromboembolic prophylaxis in intensive care unit patients and requires that prophylaxis is initiated or rationale to withhold prophylaxis is documented within 24 hours of ICU admission. In addition, venous thromboembolism (VTE) was added as a “never event” following certain orthopaedic surgeries in 2008, and many f... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415914 Sat, 01 Oct 2011 04:00:00 +0100 5415914 http://www.medworm.com/index.php?rid=5415912&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000662%2Fabstract%3Frss%3Dyes Despite significant advances in the understanding of the pathophysiology of venous thromboembolism (VTE), multiple trials evaluating and comparing VTE diagnostic modalities, and a myriad of new anticoagulants, VTE in the intensive care unit (ICU) remains difficult to detect and challenging to treat. Unfortunately, many of the diagnostic and therapeutic advances in VTE that have been made in the outpatient arena may not be applicable to the complicated ICU patient with multiple comorbidities and organ system failures and the intensivist is left to devise diagnostic and therapeutic strategies tempered by limitations in transport to diagnostic modalities, bleeding risks, and uncertain outcome data. Against this background, this issue of the Critical Care Clinics seeks to address the issue of ... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415912 Sat, 01 Oct 2011 04:00:00 +0100 5415912 http://www.medworm.com/index.php?rid=5415911&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000807%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415911 Sat, 01 Oct 2011 04:00:00 +0100 5415911 http://www.medworm.com/index.php?rid=5415910&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000790%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415910 Sat, 01 Oct 2011 04:00:00 +0100 5415910 http://www.medworm.com/index.php?rid=5415909&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000789%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415909 Sat, 01 Oct 2011 04:00:00 +0100 5415909 http://www.medworm.com/index.php?rid=5415916&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100056X%2Fabstract%3Frss%3Dyes During the last two decades, considerable progress in technology and clinical research methods have led to advances in the approach to the diagnosis, prevention, and treatment of acute venous thromboembolism (VTE). Despite this, however, the diagnosis is often delayed and preventive methods are often ignored. Thus, the morbidity and mortality associated with VTE remain high. The therapeutic approach to acute VTE is discussed, with a particular focus on the intensive care unit (ICU) setting. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415916 Fri, 30 Sep 2011 04:00:00 +0100 5415916 http://www.medworm.com/index.php?rid=5415913&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000534%2Fabstract%3Frss%3Dyes Venous thromboembolism (VTE) is a frequent but often silent complication of critical illness that has a negative impact on patient outcomes. The prevention of VTE is an essential component of patient care in the intensive care unit (ICU) setting, and is the focus of this review. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5415913 Thu, 15 Sep 2011 04:00:00 +0100 5415913 http://www.medworm.com/index.php?rid=5016277&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100042X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016277 Thu, 30 Jun 2011 23:00:00 +0100 5016277 http://www.medworm.com/index.php?rid=5016276&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000340%2Fabstract%3Frss%3Dyes Acute lung injury (ALI) involves the activation of multiple pathways leading to lung injury, resolution, and repair. Exploration of the roles of individual pathways in humans and animal models has led to a greater understanding of the complexity of ALI and the links between ALI and systemic multiorgan failure. However, there is still no integrated understanding of the initiation, the progression, and the repair of ALI. A better understanding is needed of how pathways interact in the human ALI syndrome and how complementary treatments can be used to modify the onset, severity, and outcome of ALI in humans. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016276 Thu, 30 Jun 2011 23:00:00 +0100 5016276 http://www.medworm.com/index.php?rid=5016274&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000170%2Fabstract%3Frss%3Dyes Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by acute respiratory failure and are associated with diverse disorders. Gene therapy is a potentially powerful approach to treat diseases related to ALI/ARDS, and numerous viral and nonviral methods for gene delivery to the lung have been developed. Discussed are recent advances in the development of more efficient viral and nonviral gene transfer systems, and the current status of gene therapy applied to ALI/ARDS-associated pulmonary diseases is reviewed. With the development of more efficient gene therapy vectors, gene therapy is a promising strategy for clinical application. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016274 Thu, 30 Jun 2011 23:00:00 +0100 5016274 http://www.medworm.com/index.php?rid=5016273&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000182%2Fabstract%3Frss%3Dyes This article highlights important advances in outcomes after ARDS and describes pulmonary outcomes, the most recent data on functional and neuropsychological disability in patients, health care cost, family caregivers, and early models of rehabilitation and intervention. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016273 Thu, 30 Jun 2011 23:00:00 +0100 5016273 http://www.medworm.com/index.php?rid=5016272&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000169%2Fabstract%3Frss%3Dyes This article reviews the state of the art regarding biomarkers for prediction, diagnosis, and prognosis in acute lung injury. Biomarkers and the goals of biomarker research are defined. Progress along 4 general routes is examined. First, the results of wide-ranging existing protein biomarkers are reported. Second, newer biomarkers awaiting or with strong potential for validation are described. Third, progress in the fields of genomics and proteomics is reported. Finally, given the complexity and number of potential biomarkers, the results of combining clinical predictors with protein and other biomarkers to produce better prognostic and diagnostic indices are examined. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016272 Thu, 30 Jun 2011 23:00:00 +0100 5016272 http://www.medworm.com/index.php?rid=5016271&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100025X%2Fabstract%3Frss%3Dyes The importance of nutrition support in critically ill patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) cannot be overstated. ALI and ARDS are characterized by a proinflammatory response associated with hypercatabolism that could lead to significant nutrition deficits. Nutrition support is necessary to prevent cumulative caloric deficits, malnutrition, loss of lean body mass, and deterioration of respiratory muscle strength. Furthermore, early delivery of enteral nutrition has been associated with the modulation of stress and the systemic immune response as well as the attenuation of disease severity. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016271 Thu, 30 Jun 2011 23:00:00 +0100 5016271 http://www.medworm.com/index.php?rid=5016270&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000303%2Fabstract%3Frss%3Dyes The role of extracorporeal membrane oxygenation (ECMO) in supporting adult refractory respiratory failure continues to evolve. Technical advances and the clinical challenges of H1N1 associated severe ARDS have spurred a resurgence of interest in ECMO. Published systematic review and pooled analyses point out the limitations of available studies, however, a growing body of evidence suggest potential for benefit. Referral to a specialized center with ECMO experience should be considered early after the initiation of high-level ventilator support in adult patients with severe ARDS. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016270 Thu, 30 Jun 2011 23:00:00 +0100 5016270 http://www.medworm.com/index.php?rid=5016269&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000236%2Fabstract%3Frss%3Dyes This article discusses the functional properties and management techniques of CO2 removal and intracorporeal membrane oxygenation and provides a glimpse into the future of long-term gas-exchange devices. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016269 Thu, 30 Jun 2011 23:00:00 +0100 5016269 http://www.medworm.com/index.php?rid=5016268&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000285%2Fabstract%3Frss%3Dyes This article reviews eight controlled studies evaluating corticosteroid treatment initiated before day 14 of ARDS. Available data provide a consistent strong level of evidence for improving outcomes. Treatment was also associated with a markedly reduced risk of death. This low-cost highly effective therapy is well-known, and has a low-risk profile when secondary prevention measures are implemented. The authors recommend prolonged methylprednisolone at 1 mg/kg/d initially in early ARDS, increasing to 2 mg/kg/d after 7 to 9 days of no improvement. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016268 Thu, 30 Jun 2011 23:00:00 +0100 5016268 http://www.medworm.com/index.php?rid=5016267&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000224%2Fabstract%3Frss%3Dyes The mortality for acute respiratory distress syndrome remains unacceptably high. Two vasodilators, inhaled prostacyclin and inhaled nitric oxide, are reviewed in this article. Knowledge of inhaled prostacyclin has grown substantially in the past 30 years, but less research exists about its utility in acute respiratory distress syndrome. Inhaled prostacyclin and other prostaglandin derivatives are used in acute respiratory distress syndrome with increasing frequency. Currently, only randomized controlled trials exist for inhaled nitric oxide in acute respiratory distress syndrome patients. Randomized controlled trials with consistent dosing methods are needed for both vasodilators to better define their role in the treatment of acute respiratory distress syndrome. (Source: Critical Care Cli... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016267 Thu, 30 Jun 2011 23:00:00 +0100 5016267 http://www.medworm.com/index.php?rid=5016266&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000200%2Fabstract%3Frss%3Dyes This article examines exogenous lung surfactant replacement therapy and its usefulness in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Surfactant therapy is beneficial in term infants with pneumonia and meconium aspiration lung injury, and in children up to age 21 years with direct pulmonary forms of ALI/ARDS. However, extension of exogenous surfactant therapy to adults with respiratory failure and clinical ALI/ARDS remains a challenge. This article reviews clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS, focusing on its potential advantages in patients with direct pulmonary forms of these syndromes. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016266 Thu, 30 Jun 2011 23:00:00 +0100 5016266 http://www.medworm.com/index.php?rid=5016265&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000315%2Fabstract%3Frss%3Dyes This article reviews data regarding efficacy for use of the prone position in patients with ARDS. Also described is a simple, safe, quick, and inexpensive procedure used to prone patients with severe ARDS on a standard bed in the intensive care unit at the University of Michigan. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016265 Thu, 30 Jun 2011 23:00:00 +0100 5016265 http://www.medworm.com/index.php?rid=5016264&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000248%2Fabstract%3Frss%3Dyes Airway pressure release ventilation (APRV) is an alternative mode of ventilation that is increasingly used in patients with acute respiratory failure, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS). Animal and clinical studies have demonstrated that, compared with conventional ventilation, APRV has beneficial effects on lung recruitment, oxygenation, end-organ blood flow, pulmonary vasoconstriction, and sedation requirements. Further studies, however, are required to directly compare APRV to ARDSnet protocol ventilation, specifically in patients with ALI/ARDS, and to determine whether managing ALI/ARDS with APRV will also achieve mortality reduction. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016264 Thu, 30 Jun 2011 23:00:00 +0100 5016264 http://www.medworm.com/index.php?rid=5016263&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000212%2Fabstract%3Frss%3Dyes In the last 2 decades, our goals for mechanical ventilatory support in patients with acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) have changed dramatically. Several randomized controlled trials have built on a substantial body of preclinical work to demonstrate that the way in which we employ mechanical ventilation has an impact on important patient outcomes. Avoiding ventilator-induced lung injury (VILI) is now a major focus when clinicians are considering which ventilatory strategy to employ in patients with ALI/ARDS. Physicians are searching for methods that may further limit VILI, while still achieving adequate gas exchange. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016263 Thu, 30 Jun 2011 23:00:00 +0100 5016263 http://www.medworm.com/index.php?rid=5016262&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000297%2Fabstract%3Frss%3Dyes This article reviews strategies that may help minimize ventilator-induced lung injury. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016262 Thu, 30 Jun 2011 23:00:00 +0100 5016262 http://www.medworm.com/index.php?rid=5016261&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000327%2Fabstract%3Frss%3Dyes To hasten the development of effective therapy for acute respiratory distress syndrome (ARDS), in 1994, the National Heart, Lung, and Blood Institute initiated a clinical network to carry out multicenter clinical trials of ARDS treatments. The ARDS Network is a clinical research network of approximately 42 hospitals, organized into 12 clinical sites. The goal of the Network is to efficiently test promising agents, devices, or management strategies to improve the care of patients with ARDS. Comprehensive information regarding all completed and ongoing ARDSNet clinical trials is available at www.ardsnet.org, but a brief summary is provided in this article. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016261 Thu, 30 Jun 2011 23:00:00 +0100 5016261 http://www.medworm.com/index.php?rid=5016260&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000261%2Fabstract%3Frss%3Dyes This article identifies the most significant studies and systematic reviews of recent years, defining the incidence, mortality, risk and prognostic factors, and etiologic classes of ARDS/ALI. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016260 Thu, 30 Jun 2011 23:00:00 +0100 5016260 http://www.medworm.com/index.php?rid=5016259&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000273%2Fabstract%3Frss%3Dyes Although acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are caused by different injuries and conditions, their similar clinical picture makes a compelling case for them to be studied as a single entity. An array of potential specific targets for pharmacologic intervention can be applied to ALI/ARDS as one disease. Although a working definition of ALI/ARDS that includes pulmonary and extrapulmonary causes can have benefit in standardizing supportive care, it can also complicate assessments of the efficacy of therapeutic interventions. In this article, definitions that have been recently used for ALI/ARDS in various clinical studies are discussed individually. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016259 Thu, 30 Jun 2011 23:00:00 +0100 5016259 http://www.medworm.com/index.php?rid=5016257&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000418%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016257 Thu, 30 Jun 2011 23:00:00 +0100 5016257 http://www.medworm.com/index.php?rid=5016256&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000406%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016256 Thu, 30 Jun 2011 23:00:00 +0100 5016256 http://www.medworm.com/index.php?rid=5016255&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100039X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016255 Thu, 30 Jun 2011 23:00:00 +0100 5016255 http://www.medworm.com/index.php?rid=5016258&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000339%2Fabstract%3Frss%3Dyes Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening diseases, and patients with ALI/ARDS require extensive critical care support for treatment of acute respiratory failure with hypoxemia and hypercarbia, and support of other failing organs. This issue of Critical Care Clinics is aimed at providing an overview of the significant advances that have been made in the last decade in the understanding and treatment of this disease, and the persistent challenges that still remain. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016258 Thu, 26 May 2011 23:00:00 +0100 5016258 http://www.medworm.com/index.php?rid=5016275&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000194%2Fabstract%3Frss%3Dyes Acute respiratory distress syndrome (ARDS) is a clinical syndrome of acute respiratory failure presenting with hypoxemia and bilateral pulmonary infiltrates, most often in the setting of pneumonia, sepsis, or major trauma. The pathogenesis of ARDS involves lung endothelial injury, alveolar epithelial injury, and the accumulation of protein-rich fluid and cellular debris in the alveolar space. No pharmacologic therapy has so far proved effective. A potential strategy involves cell-based therapies, including mesenchymal stem cells (MSCs). Herein we review basic properties of MSCs, their use in preclinical models of lung injury and ARDS, and potential therapeutic mechanisms. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=5016275 Tue, 24 May 2011 23:00:00 +0100 5016275 http://www.medworm.com/index.php?rid=4640390&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100011X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640390 Mon, 28 Mar 2011 16:08:47 +0100 4640390 http://www.medworm.com/index.php?rid=4640389&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000117X%2Fabstract%3Frss%3Dyes In clinical practice, physicians frequently use combination therapy despite the conflicting evidence for its effectiveness. The results of recent studies have contributed to our understanding of this important issue. In this article, we examine the evidence for, or against, the use of combination drug therapy compared with monotherapy in the management of serious infections, sepsis, and septic shock. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640389 Mon, 28 Mar 2011 16:08:47 +0100 4640389 http://www.medworm.com/index.php?rid=4640388&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001284%2Fabstract%3Frss%3Dyes The future application of biomarkers in critical illness will be to select and guide therapy. Specific biomarkers could identify a pathophysiologic perturbation or noxious mediator to counteract or the need to replete a deficient protective protein. Functional genomics could identify patients at risk for illness or at risk for a poor outcome in critical illness. Genetic expression studies could help differentiate patients with sepsis from those with noninfectious inflammation and could also help to monitor illnesses over time. Expressional and functional proteomics could lead to the identification of new biomarkers and organ-specific therapies. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640388 Mon, 28 Mar 2011 16:08:47 +0100 4640388 http://www.medworm.com/index.php?rid=4640387&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001272%2Fabstract%3Frss%3Dyes This article reviews several studies using multimarker panels, and highlights the potential of more sophisticated diagnostic and prognostic techniques in future multimarker panels. More complex algorithms should accelerate the adoption of multimarker panels into the routine management of patients with sepsis, provided that clinicians understand the multimarker approach. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640387 Mon, 28 Mar 2011 16:08:47 +0100 4640387 http://www.medworm.com/index.php?rid=4640386&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001193%2Fabstract%3Frss%3Dyes Based on information to date, although limitations in the accuracy of NGAL in predicting AKI persist, the preponderance of published studies demonstrate that NGAL, when measured in the plasma and in the urine, is a reliable biomarker for the subsequent development of clinically apparent AKI. If very early detection of AKI, via the measurement of plasma or urinary NGAL, can be followed by effective treatment to abort the development or limit the severity of AKI, and therefore decrease the rate of RRT, length of hospitalization stay, and/or mortality risk, NGAL measurement will become a critically important diagnostic tool in critical care medicine, pediatrics, and surgery. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640386 Mon, 28 Mar 2011 16:08:47 +0100 4640386 http://www.medworm.com/index.php?rid=4640385&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001211%2Fabstract%3Frss%3Dyes Studies of potential biomarkers of acute lung injury (ALI) have provided information relating to the pathophysiology of the mechanisms of lung injury and repair. The utility of biomarkers remains solely among research tools to investigate lung injury and repair mechanisms. Because of lack of sensitivity and specificity, they cannot be used in decision making in patients with ALI or acute respiratory distress syndrome. The authors reviewed known biomarkers in context of their major biologic activity. The continued interest in identifying and studying biomarkers is relevant, as it provides information regarding the mechanisms involved in lung injury and repair and how this may be helpful in identifying and designing future therapeutic targets and strategies and possibly identifying a sensiti... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640385 Mon, 28 Mar 2011 16:08:47 +0100 4640385 http://www.medworm.com/index.php?rid=4640384&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001181%2Fabstract%3Frss%3Dyes This article discusses several biomarkers, including emerging ones, for infection and sepsis following trauma including inflammatory cytokines, intracellular proteins, and cellular biomarkers. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640384 Mon, 28 Mar 2011 16:08:47 +0100 4640384 http://www.medworm.com/index.php?rid=4640383&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000120X%2Fabstract%3Frss%3Dyes This article briefly describes what constitutes an ideal biomarker and focuses on those that have been most well studied in critical illness, specifically troponin, the natriuretic peptides, and heart-type fatty acid–binding protein. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640383 Mon, 28 Mar 2011 16:08:47 +0100 4640383 http://www.medworm.com/index.php?rid=4640382&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001296%2Fabstract%3Frss%3Dyes Lactate levels are frequently elevated in critically ill patients and correlate well with disease severity. Elevated lactate levels are prognostic in prehospital, emergency department, and intensive care unit settings. This review discusses the role of lactate as a biomarker in diagnosing and assessing the severity of systemic hypoperfusion, as well as the role of serum lactate measurements in guiding clinical care and enabling prognosis in critically ill patients. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640382 Mon, 28 Mar 2011 16:08:47 +0100 4640382 http://www.medworm.com/index.php?rid=4640381&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001259%2Fabstract%3Frss%3Dyes This article discusses coagulation biomarkers in critically ill patients where coagulation abnormalities occur frequently and may have a major impact on the outcome. An adequate explanation for the cause is important, since many underlying disorders may require specific treatment and supportive therapy directed at the underlying condition. Deficiencies in platelets and coagulation factors in bleeding patients or patients at risk for bleeding can be achieved by transfusion of platelet concentrate or plasma products, respectively. Prohemostatic treatment may be beneficial in case of severe bleeding, whereas restoring physiological anticoagulant pathways may be helpful in patients with sepsis and disseminated intravascular coagulation. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640381 Mon, 28 Mar 2011 16:08:47 +0100 4640381 http://www.medworm.com/index.php?rid=4640380&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001223%2Fabstract%3Frss%3Dyes This article reports on the potential usefulness of the assessment of the soluble form of TREM-1 in biologic fluids in the diagnosis of infection. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640380 Mon, 28 Mar 2011 16:08:47 +0100 4640380 http://www.medworm.com/index.php?rid=4640379&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000030%2Fabstract%3Frss%3Dyes Infection and/or sepsis biomarkers should help to make the diagnosis and thus initiate therapy earlier, help to differentiate between infectious and sterile inflammation, allow the use of more-specific antimicrobials, shorten the time of antimicrobial use, and ideally identify distinct phenotypes that may benefit from specific adjunctive sepsis therapies. Procalcitonin (PCT) was proposed as a sepsis and infection marker more than 15 years ago. Meanwhile, PCT has been evaluated in various clinical settings. In this review the present use of PCT on the ICU and in critically ill patients is summarized, included it's role for diagnosis of severe sepsis and septic shock and antibiotic stewardship with PCT. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640379 Mon, 28 Mar 2011 16:08:47 +0100 4640379 http://www.medworm.com/index.php?rid=4640378&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001260%2Fabstract%3Frss%3Dyes Levels of C-reactive protein (CRP), an acute phase protein, are elevated in many inflammatory conditions and are used to detect and follow disease in many fields of medicine, including rheumatology, gastroenterology, and cardiology. CRP concentrations are also used in critically ill patients, notably because they are increased during the inflammatory response to infection, that is, sepsis. However, CRP is not specific for sepsis, and serum CRP concentrations need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640378 Mon, 28 Mar 2011 16:08:47 +0100 4640378 http://www.medworm.com/index.php?rid=4640377&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001247%2Fabstract%3Frss%3Dyes Sepsis generates an overwhelming host response characterized by changes in physiologic parameters. Monitoring these parameters can help identify and stratify septic patients. Recognizing sepsis early and identifying septic patients at risk of worsening are keys to successful treatment. Several studies have analyzed the independent physiologic parameters associated with the diagnosis of sepsis or bacteremia, with the development of severe sepsis or septic shock, and with mortality. Physiologic variability of heart rate and body temperature is reduced in sepsis and measuring the variability of these parameters can be useful for the diagnosis and prognosis of sepsis. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640377 Mon, 28 Mar 2011 16:08:47 +0100 4640377 http://www.medworm.com/index.php?rid=4640376&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001235%2Fabstract%3Frss%3Dyes Biomarkers are frequently used in critically ill patients, especially during inflammatory and/or infectious diseases such as severe sepsis and septic shock. The rationale of when to measure laboratory parameters, which marker may be useful, and how to interpret the results is not well defined. Terms like sensitive, predictive, or significant to describe the capabilities of specific markers are often mixed up or misused, which may have fatal consequences regarding diagnosis and treatment. This review reflects some statistical basics with clinical examples, showing possibilities as well as limitations of how data for biomarkers may be used in critically ill patients. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640376 Mon, 28 Mar 2011 16:08:46 +0100 4640376 http://www.medworm.com/index.php?rid=4640375&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000029%2Fabstract%3Frss%3Dyes Prompt diagnosis and early intervention in critically ill patients have come to be appreciated as perhaps the primary determinant in good outcomes across several critical disease states: Early institution of appropriate antibiotics for sepsis, minimizing time to balloon dilatation for acute coronary syndrome, initiation of rapid, aggressive fluid resuscitation in severe sepsis and shock have all been shown to improve outcomes in critically ill patients. In addition, accurate risk assessment to guide treatment and disposition, such as identifying and treating patients with right ventricular failure or submassive and massive pulmonary embolism, has also been recognized as a crucial ingredient in the early management of the critically ill patient. Of course, the daunting challenge that bedsid... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640375 Mon, 28 Mar 2011 16:08:46 +0100 4640375 http://www.medworm.com/index.php?rid=4640374&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000108%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640374 Mon, 28 Mar 2011 16:08:46 +0100 4640374 http://www.medworm.com/index.php?rid=4640373&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070411000091%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640373 Mon, 28 Mar 2011 16:08:46 +0100 4640373 http://www.medworm.com/index.php?rid=4640372&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041100008X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4640372 Mon, 28 Mar 2011 16:08:46 +0100 4640372 http://www.medworm.com/index.php?rid=4257321&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001120%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257321 Tue, 14 Dec 2010 18:14:39 +0100 4257321 http://www.medworm.com/index.php?rid=4257320&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000990%2Fabstract%3Frss%3Dyes This article reviews basic concepts of resistance to antibacterial agents including mechanisms and modes of transmission, and discusses management issues for the important drug-resistant pathogens found in the ICU. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257320 Tue, 14 Dec 2010 18:14:39 +0100 4257320 http://www.medworm.com/index.php?rid=4257319&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000710%2Fabstract%3Frss%3Dyes Antibiotic de-escalation is a mechanism whereby the provision of effective initial antibiotic treatment is achieved while avoiding unnecessary antibiotic use that would promote the development of resistance. It is a key element within antimicrobial stewardship programs and treatment paradigms for serious sepsis. The embodiment of de-escalation is that based on microbiology results around the day 3 therapy point; the empiric antibiotic(s) that were started are stopped or reduced in number and/or narrowed in spectrum. Data are presented here which demonstrate that de-escalation is clinically effective and appropriate. However, the need for further studies, particularly in terms of realization of full benefits as well as implementation tools, is highlighted. De-escalation ought now to form a ... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257319 Tue, 14 Dec 2010 18:14:38 +0100 4257319 http://www.medworm.com/index.php?rid=4257318&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000989%2Fabstract%3Frss%3Dyes Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Outcomes continue to be suboptimal; however, there are a few key clinician modifiable factors. PK-PD studies with the approved antifungal agents have provided guidance on the dosing strategy that predicts improved outcome. In addition, time to therapy is a critical element. Therefore early recognition through improved risk factor analysis and diagnostics will be key developments. Source control for infected devices and endophthalmitis must be considered. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257318 Tue, 14 Dec 2010 18:14:38 +0100 4257318 http://www.medworm.com/index.php?rid=4257317&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000103X%2Fabstract%3Frss%3Dyes This article reviews the pharmacokinetics, pharmacodynamics, and toxicodynamics of aminoglycosides, describing dosing strategies and other effects to improve outcomes in critically ill patients with serious infections. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257317 Tue, 14 Dec 2010 18:14:38 +0100 4257317 http://www.medworm.com/index.php?rid=4257316&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001028%2Fabstract%3Frss%3Dyes Fluoroquinolones have become a staple antimicrobial in a variety of settings for a wide spectrum of infectious diseases. Although fluoroquinolones have been associated with a broad spectrum of adverse events, the side effect profile is generally acceptable. Their use in the intensive care unit as empiric therapy is becoming compromised due to the development of multiple drug resistant gram negative pathogens and collateral damage with C difficile & MRSA. Fluoroquinolones should be used along with another antibiotic of different chemical structure, mechanism of action, and pharmacodynamic profile to ensure adequate initial antimicrobial coverage and maximize the likelihood of a favorable clinical and microbiologic response. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257316 Tue, 14 Dec 2010 18:14:38 +0100 4257316 http://www.medworm.com/index.php?rid=4257315&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001016%2Fabstract%3Frss%3Dyes This article discusses the pharmacology behind these dosing strategies and presents some of the contemporary literature describing the perceived and observed clinical benefits. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257315 Tue, 14 Dec 2010 18:14:38 +0100 4257315 http://www.medworm.com/index.php?rid=4257314&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000709%2Fabstract%3Frss%3Dyes For decades, health care workers faced the challenge of how to adequately treat life-threatening infections. To a great extent, the primary focus on improving outcomes has centered on improvement in resuscitation, deployment of antimicrobials of increasing potency, and development of novel adjunctive therapies. However, the current studies conclusively show that early recognition of life threatening infection and rapid initiation of appropriate antimicrobial therapy is the critical element in reducing mortality. If “Time is tissue” when it comes to thrombolytic therapy for acute myocardial infarction and thrombotic stroke, then an appropriate rule for life-threatening infections, particularly septic shock, is “Speed is life.” (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257314 Tue, 14 Dec 2010 18:14:38 +0100 4257314 http://www.medworm.com/index.php?rid=4257313&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000692%2Fabstract%3Frss%3Dyes Inappropriate empirical antibiotic therapy for severe infections in the intensive care unit is a modifiable prognostic factor that has a great effect on patient outcome and health care resources. Inappropriate treatment is usually associated with microorganisms resistant to the common antibiotics, which must be empirically targeted when risk factors are present. Previous antibiotic exposure, prolonged length of hospital stay, admission category, local susceptibilities, colonization pressure, and the presence of invasive devices increase the likelihood of infection by resistant pathogens. Consideration of issues beyond in vitro susceptibility, such as antibiotic physicochemistry, tissue penetration, and pharmacokinetic/pharmacodynamic-driven dosing, is mandatory for the optimization of ant... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257313 Tue, 14 Dec 2010 18:14:38 +0100 4257313 http://www.medworm.com/index.php?rid=4257312&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000680%2Fabstract%3Frss%3Dyes Antimicrobial pharmacokinetics (PK) and pharmacodynamics (PD) are important considerations, particularly in critically ill patients with severe sepsis and septic shock. The pathophysiologic changes that occur in these conditions can have a major effect on pharmacokinetic parameters, which in turn could result in failure to achieve pharmacodynamic targets for antimicrobials thus adversely affecting clinical outcome. This paper discusses the pathophysiologic changes that occur during severe sepsis and septic shock and the consequent effects on antimicrobial PK and PD. The effect of PK/PD on specific antimicrobial classes is discussed and a rational framework for antimicrobial dosing is provided. Knowledge of PK/PD properties of antimicrobials can be used to personalize dosing regimens not on... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257312 Tue, 14 Dec 2010 18:14:38 +0100 4257312 http://www.medworm.com/index.php?rid=4257311&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001004%2Fabstract%3Frss%3Dyes This article reviews the principles of antimicrobial pharmacokinetics and pharmacodynamics in the context of the ICU for the most commonly used antibiotics. For therapy to truly be efficacious, the regimen must be effective against the organism, but not harmful to the patient. We review how optimization of chemotherapy requires a careful balancing of efficacy against toxicity when selecting dose and dose schedules. In addition, we discuss the importance of considering concentrations at the site of infection and how dose optimization can help suppress resistance emergence and preserve our antimicrobial armamentarium for the future. Finally, we examine combination chemotherapy and strategies for optimizing the administration of multiple agents. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257311 Tue, 14 Dec 2010 18:14:38 +0100 4257311 http://www.medworm.com/index.php?rid=4257310&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001041%2Fabstract%3Frss%3Dyes Since the advent of modern antimicrobial therapy with the introduction of penicillin over 50 years ago, the focus of the pharmaceutical scientists and clinicians has primarily been on the development of ever more potent and broad spectrum agents to counter the inevitable and inexorable expansion of antimicrobial resistance. In that regard, pharmaceutical science has been tremendously successful with dozens of classes of antimicrobials and hundreds of individual agents now available around the globe. Yet, the problem of resistance has continued unabated to the point that some pathogens appear impervious to virtually every known antimicrobial. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257310 Tue, 14 Dec 2010 18:14:37 +0100 4257310 http://www.medworm.com/index.php?rid=4257309&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001119%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257309 Tue, 14 Dec 2010 18:14:37 +0100 4257309 http://www.medworm.com/index.php?rid=4257308&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001107%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257308 Tue, 14 Dec 2010 18:14:37 +0100 4257308 http://www.medworm.com/index.php?rid=4257307&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410001090%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4257307 Tue, 14 Dec 2010 18:14:37 +0100 4257307 http://www.medworm.com/index.php?rid=4094631&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000059X%2Fabstract%3Frss%3Dyes The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. In many centers, nutritional decision making is based on predictive formulas, which have been shown to underestimate true energy requirements. Such estimations are ideally performed using indirect calorimetry. Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry w... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094631 Thu, 30 Sep 2010 23:00:00 +0100 4094631 http://www.medworm.com/index.php?rid=4094630&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000795%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094630 Thu, 30 Sep 2010 23:00:00 +0100 4094630 http://www.medworm.com/index.php?rid=4094629&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000667%2Fabstract%3Frss%3Dyes Caring for the obese patient requires sensitivity by health care professionals not only to the patient but also to the family members. Our personal opinions need to be set aside when providing care. Sensitivity training can be an eye-opening experience for health care workers as some do not realize they have such a bias to obesity. In several studies, physicians and nursing personnel were found to have weight bias and overall negative feelings about obese patients. This negative bias has an impact on the obese patient both psychologically and physically. Being sensitive to the obese patient and their families instills confidence and reassurance in their health care providers. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094629 Thu, 30 Sep 2010 23:00:00 +0100 4094629 http://www.medworm.com/index.php?rid=4094628&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000564%2Fabstract%3Frss%3Dyes The critically ill pregnant patient poses a unique challenge to the clinician, requiring a thorough understanding of normal and abnormal maternal and fetal physiology associated with pregnancy. The morbidly obese patient presents even greater challenges to the clinician, and morbidity and mortality are proportionately increased. Because increased numbers of obese pregnant women are now admitted to intensive care units, practitioners must be aware of the physiology associated with both pregnancy and obesity. A multidisciplinary approach is imperative to prevent both maternal and fetal morbidity and mortality for these very complex patients, especially when they are admitted to the ICU with critical illness. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094628 Thu, 30 Sep 2010 23:00:00 +0100 4094628 http://www.medworm.com/index.php?rid=4094625&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000631%2Fabstract%3Frss%3Dyes As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094625 Thu, 30 Sep 2010 23:00:00 +0100 4094625 http://www.medworm.com/index.php?rid=4094623&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000588%2Fabstract%3Frss%3Dyes Despite the growing epidemic of obesity in the United States, dosing medications in such patients remains poorly studied and understood. Most recommendations are based on small independent studies, case reports, and expert opinion. Applying manufacturer kinetics and dosing recommendations in the obese patient may result in toxicity or treatment failure, leading to increased morbidity, mortality, and hospital length of stay. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094623 Thu, 30 Sep 2010 23:00:00 +0100 4094623 http://www.medworm.com/index.php?rid=4094622&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000062X%2Fabstract%3Frss%3Dyes This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094622 Thu, 30 Sep 2010 23:00:00 +0100 4094622 http://www.medworm.com/index.php?rid=4094621&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000655%2Fabstract%3Frss%3Dyes Morbidly obese patients have a much higher incidence of obstructive sleep apnea (OSA) and also have altered respiratory physiology, including decreased respiratory compliance and increased airway resistance. Morbidly obese patients with ventilatory-dependent respiratory failure (VDRF) are more difficult to wean and extubate. Both OSA and VDRF are common indications of a tracheotomy in this patient population. Although there is a clear benefit to tracheotomy in obese patients with OSA and VDRF, this must be weighed against the increased surgical morbidity and mortality resulting from the patient’s obesity. The 30-day postoperative mortality rate for a tracheotomy in the morbidly obese has been shown to be as high as 29%. With an elevated body mass index, the increased submental and anteri... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094621 Thu, 30 Sep 2010 23:00:00 +0100 4094621 http://www.medworm.com/index.php?rid=4094620&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000643%2Fabstract%3Frss%3Dyes Performance of procedures upon the obese critically ill patient in the ICU or in the radiology suite, require certain considerations. Additional staff, equipment and proper ergonomics are often necessary to perform these procedures safely for both patient and staff. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094620 Thu, 30 Sep 2010 23:00:00 +0100 4094620 http://www.medworm.com/index.php?rid=4094619&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000576%2Fabstract%3Frss%3Dyes This article discusses lumbar puncture in patients with a high BMI. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094619 Thu, 30 Sep 2010 23:00:00 +0100 4094619 http://www.medworm.com/index.php?rid=4094618&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000618%2Fabstract%3Frss%3Dyes This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094618 Thu, 30 Sep 2010 23:00:00 +0100 4094618 http://www.medworm.com/index.php?rid=4094617&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000606%2Fabstract%3Frss%3Dyes This article discusses the risk factors for a difficult airway and the methods of managing the airway. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094617 Thu, 30 Sep 2010 23:00:00 +0100 4094617 http://www.medworm.com/index.php?rid=4094616&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000436%2Fabstract%3Frss%3Dyes Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094616 Thu, 30 Sep 2010 23:00:00 +0100 4094616 http://www.medworm.com/index.php?rid=4094614&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000394%2Fabstract%3Frss%3Dyes A growing body of literature suggests multifaceted alterations to the immune function in obese patients compared with a lean cohort. Although treatment in the intensive care unit has an associated risk of infectious complications, which, if any, of these immunologic alterations are causal is unclear. Obesity clearly causes abundant alterations to the immune system. Overall, the aggregate effect seems to be chronic activation of inflammatory mediators. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094614 Thu, 30 Sep 2010 23:00:00 +0100 4094614 http://www.medworm.com/index.php?rid=4094613&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000382%2Fabstract%3Frss%3Dyes Several significant changes occur in the gastrointestinal system with obesity that can effect management in critical illness. This population is at risk for gastroesophageal reflux disease (GERD), abdominal compartment syndrome, nonalcoholic fatty liver disease (NAFLD), and an increased incidence of cholelithiasis. It is important for critical care providers to be aware of these potential complicating factors. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094613 Thu, 30 Sep 2010 23:00:00 +0100 4094613 http://www.medworm.com/index.php?rid=4094612&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000370%2Fabstract%3Frss%3Dyes This article examines the literature pertinent to AKI in critically ill MO patients. After a concise review of the available epidemiologic data regarding the incidence of acute renal injury in MO individuals, the authors review the limitations and available tools for estimation of renal function in the MO population (with emphasis on the critical illness). Also described are several specific types of renal injury previously described in this population that are applicable to the critical care setting. Lastly, the authors review some of the challenges and limitations in providing renal support to critically ill MO individuals, and identify potential areas for future research in this population. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094612 Thu, 30 Sep 2010 23:00:00 +0100 4094612 http://www.medworm.com/index.php?rid=4094609&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000369%2Fabstract%3Frss%3Dyes The term “obesity paradox” refers to the observation that, although obesity is a major risk factor in the development of cardiovascular and peripheral vascular disease, when acute cardiovascular decompensation occurs, for example, in myocardial infarction or congestive heart failure, obese patients may have a survival benefit. In addition, it has been suggested that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery. Moreover, it appears that obese men with chronic hypertensive heart disease live longer than men of normal weight. Mounting evidence shows that obesity alone may confer a survival benefit independent of age, medical care, or therapy. Perhaps the definition of obesity needs to be revisited, and it is also possible th... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094609 Thu, 30 Sep 2010 23:00:00 +0100 4094609 http://www.medworm.com/index.php?rid=4094608&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000679%2Fabstract%3Frss%3Dyes As critical care practitioners, we have seen our ICU transformed over the last 20 years from a facility challenged with the care of an occasional morbidly obese patient to one that cares for multiple morbidly obese patients on a daily basis. Nevertheless, our approach to the management continues to be primarily empiric and without guidance from clinical research directed toward this population of patients. Although research is evolving in this area, large gaps in knowledge persist. Optimal dosing, for example, is unknown for many drugs, including those that may be lifesaving. Although a modest body of literature exists on antibiotic dosing in the obese, the studies addressing dosing of cardiac medications in these patients are infrequent and sporadic. Controversy continues to persist over ... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094608 Thu, 30 Sep 2010 23:00:00 +0100 4094608 http://www.medworm.com/index.php?rid=4094607&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000783%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094607 Thu, 30 Sep 2010 23:00:00 +0100 4094607 http://www.medworm.com/index.php?rid=4094606&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000771%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094606 Thu, 30 Sep 2010 23:00:00 +0100 4094606 http://www.medworm.com/index.php?rid=4094605&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000076X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094605 Thu, 30 Sep 2010 23:00:00 +0100 4094605 http://www.medworm.com/index.php?rid=4094627&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000333%2Fabstract%3Frss%3Dyes This article focuses on management of the morbidly obese patients during disasters. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094627 Sun, 08 Aug 2010 23:00:00 +0100 4094627 http://www.medworm.com/index.php?rid=4094626&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000412%2Fabstract%3Frss%3Dyes Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094626 Sun, 25 Jul 2010 23:00:00 +0100 4094626 http://www.medworm.com/index.php?rid=4094624&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000424%2Fabstract%3Frss%3Dyes This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094624 Sun, 25 Jul 2010 23:00:00 +0100 4094624 http://www.medworm.com/index.php?rid=4094611&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000357%2Fabstract%3Frss%3Dyes This article highlights these strategies. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094611 Sun, 25 Jul 2010 23:00:00 +0100 4094611 http://www.medworm.com/index.php?rid=4094615&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000345%2Fabstract%3Frss%3Dyes This article highlights the complexities of treating endocrine system disorders in obese patients. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094615 Thu, 22 Jul 2010 23:00:00 +0100 4094615 http://www.medworm.com/index.php?rid=4094610&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000400%2Fabstract%3Frss%3Dyes There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=4094610 Thu, 22 Jul 2010 23:00:00 +0100 4094610 http://www.medworm.com/index.php?rid=3771054&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000515%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771054 Wed, 30 Jun 2010 23:00:00 +0100 3771054 http://www.medworm.com/index.php?rid=3771053&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000278%2Fabstract%3Frss%3Dyes This article presents a clear role for mitochondrial dysfunction in the pathogenesis and pathophysiology of sepsis. What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771053 Wed, 30 Jun 2010 23:00:00 +0100 3771053 http://www.medworm.com/index.php?rid=3771052&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000254%2Fabstract%3Frss%3Dyes The intestine plays a central role in the pathophysiology of critical illness and is frequently called the “motor” of the systemic inflammatory response. Perturbations to the intestinal barrier can lead to distant organ damage and multiple organ failure. Therefore, identifying ways to preserve intestinal integrity may be of paramount importance. Growth factors and other peptides have emerged as potential tools for modulation of intestinal inflammation and repair due to their roles in cellular proliferation, differentiation, migration, and survival. This review examines the involvement of growth factors and other peptides in intestinal epithelial repair during critical illness and their potential use as therapeutic targets. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771052 Wed, 30 Jun 2010 23:00:00 +0100 3771052 http://www.medworm.com/index.php?rid=3771051&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000230%2Fabstract%3Frss%3Dyes Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to attenuate the stress response during the patients' journey through a surgical procedure to facilitate the maintenance of preoperative bodily compositions and organ function and in doing so achieve early recovery. The key factors that keep patients in hospital after uncomplicated major abdominal surgery include the need for parenteral analgesia, intravenous fluids secondary to persistent gut dysfunction, and bed rest caused by lack of mobility. The elements of the ERAS pathways are aimed to address these issues and the interventions that facilitate early recovery cover all three phases of the perioperative period during the patients' journey. They also provide clear guidance to all members of the c... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771051 Wed, 30 Jun 2010 23:00:00 +0100 3771051 http://www.medworm.com/index.php?rid=3771050&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000266%2Fabstract%3Frss%3Dyes Glutamine (GLN) has been shown to be a key pharmaconutrient in the body's response to stress and injury. It exerts its protective effects via multiple mechanisms, including direct protection of cells and tissue from injury, attenuation inflammation, and preservation of metabolic function. Data support GLN as an ideal pharmacologic intervention to prevent or treat multiple organ dysfunction syndrome after sepsis or other injuries in the intensive care unit population. A large and growing body of clinical data shows that in well-defined critically ill patient groups GLN can be a life-saving intervention. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771050 Wed, 30 Jun 2010 23:00:00 +0100 3771050 http://www.medworm.com/index.php?rid=3771049&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000291%2Fabstract%3Frss%3Dyes Fish oil is rich in omega-3 fatty acids, which have been shown to be beneficial in multiple disease states that involve an inflammatory process. It is now hypothesized that omega-3 fatty acids may decrease the inflammatory response and be beneficial in critical illness. After a review of the mechanisms of omega-3 fatty acids in inflammation, research using enteral nutrition formulas and parenteral nutrition lipid emulsions fortified with fish oil were examined. The results of this research to date are inconclusive for both enteral and parenteral omega-3 fatty acid administration. More research is required before definitive recommendations can be made on fish oil supplementation in critical illness. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771049 Wed, 30 Jun 2010 23:00:00 +0100 3771049 http://www.medworm.com/index.php?rid=3771048&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000242%2Fabstract%3Frss%3Dyes T cell dysfunction significantly increases susceptibility to infections and organ failure after trauma or surgery (physical injury). This coincides with a persistent drop in arginine availability, a necessary amino acid for normal T cell function. Recent data led to the identification of a novel mechanism of T cell suppression caused by the depletion of arginine through the induction of arginase 1 (ARG1) in a specialized group of immature myeloid cells, now named myeloid-derived suppressor cells (MDSC). In addition to T cell dysfunction, arginine depletion leads to the decrease in nitric oxide (NO) production. Dietary therapy containing arginine at supraphysiologic concentrations along with other components such as omega-3 fat acids, antioxidants, nucleotides, and vitamin A is associated w... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771048 Wed, 30 Jun 2010 23:00:00 +0100 3771048 http://www.medworm.com/index.php?rid=3771047&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000308%2Fabstract%3Frss%3Dyes This article reviews studies showing the fallacies of these assumptions. Although clinicians are unlikely to stop using GRVs, interpretation of these must be modified so as not to interrupt the delivery of EN. Using a protocol that directs appropriate responses to elevated GRVs should promote the delivery of EN and improve patient outcome. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771047 Wed, 30 Jun 2010 23:00:00 +0100 3771047 http://www.medworm.com/index.php?rid=3771046&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000229%2Fabstract%3Frss%3Dyes Total parenteral nutrition was developed in the 1960s and has since been implemented commonly in the intensive care unit (ICU). Studies published in the 1980s and early 1990s indicate that the use of total parenteral nutrition is associated with increased mortality and infectious morbidity. These detrimental effects were related to hyperglycemia and overnutrition at a period when parenteral nutrition was not administered according to the all-in-one principle. Because of its beneficial effects on the gastrointestinal tract, enteral nutrition alone replaced parenteral nutrition as the gold standard of nutritional care in the ICU in the 1980s. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequent protein–energy defici... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771046 Wed, 30 Jun 2010 23:00:00 +0100 3771046 http://www.medworm.com/index.php?rid=3771045&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000028X%2Fabstract%3Frss%3Dyes The volume of clinical guidelines produced by national and international societies has virtually exploded in the literature over the past decade. The most important aspect of guidelines is transparency, that is, the connection between the recommendation or guideline statement and the underlying supportive studies from the literature should be transparent. Clinical guidelines should help organize the literature, identify key areas of patient management, and provide a framework with which the clinician may operate. The reader of a guideline should embrace controversy, trace back and review the underlying literature, and then determine whether practice should be altered as a result of the guideline recommendations. The purpose of this article is to understand the derivation of clinical guidel... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771045 Wed, 30 Jun 2010 23:00:00 +0100 3771045 http://www.medworm.com/index.php?rid=3771044&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000217%2Fabstract%3Frss%3Dyes Maintenance of nutritional status is particularly challenging during critical illness. There is a common perception of a race against the clock to adequately feed the patient to prevent or minimize the sometimes catastrophic muscle wasting and general catabolic state that can result in the patient's deterioration. However, the course of critical illness may be separated into 3 phases, each with highly differing metabolic needs. The initial phase, in which the body attempts to fight the acute insult, is generally hypermetabolic. When the body fails to overcome the insult, it enters into a second phase, which is akin to hibernation. This stage is characterized by a functional metabolic shutdown triggered either by a lack of adequate energy supply or perhaps by the direct switching off of met... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771044 Wed, 30 Jun 2010 23:00:00 +0100 3771044 http://www.medworm.com/index.php?rid=3771043&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000031X%2Fabstract%3Frss%3Dyes At present, we are in a “revival” period in clinical nutrition in critical care, especially in the area of “pharmaconutrition.” Adequate nutrition may hinge not only on how many calories are provided but also on the ability to provide key pharmacologically acting nutrients. Traditionally, nutrition has been viewed as vital for metabolism, growth, and repair. But, it is now known that some nutrients, when given in therapeutic doses, appear to serve as pharmacologic agents to improve clinically relevant outcomes. Thus, larger therapeutic doses of specific nutrients may be required to replace acute deficiencies brought on by specific injury or disease states. Recent data also imply that the number of calories and protein delivered early in the intensive care unit (ICU) stay has a sign... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771043 Wed, 30 Jun 2010 23:00:00 +0100 3771043 http://www.medworm.com/index.php?rid=3771042&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000321%2Fabstract%3Frss%3Dyes “Our food should be our medicine and our medicine should be our food.” —Hippocrates (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771042 Wed, 30 Jun 2010 23:00:00 +0100 3771042 http://www.medworm.com/index.php?rid=3771041&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000503%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771041 Wed, 30 Jun 2010 23:00:00 +0100 3771041 http://www.medworm.com/index.php?rid=3771040&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000497%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771040 Wed, 30 Jun 2010 23:00:00 +0100 3771040 http://www.medworm.com/index.php?rid=3771039&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000485%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3771039 Wed, 30 Jun 2010 23:00:00 +0100 3771039 http://www.medworm.com/index.php?rid=3452627&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907041000014X%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452627 Wed, 31 Mar 2010 23:00:00 +0100 3452627 http://www.medworm.com/index.php?rid=3452626&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001262%2Fabstract%3Frss%3Dyes Organ function is critically linked to the way tissues use available oxygen. In sepsis, tissue-related hypoxic injury is the result of hypoxemia and hypoperfusion and cytokine-mediated mitochondrial dysfunction termed cytopathic hypoxia. Organ dysfunction in sepsis is more likely related to derailment of the metabolic processes of cells to use available oxygen. Cellular dysoxia rather than hypoxia may be the most appropriate way of describing sepsis-related tissue injury. Lactate is a marker of aerobic mitochondrial dysfunction and anaerobic tissue metabolism and in some circumstances is considered the fuel of choice for certain tissues. The concept of cellular metabolic derangement or cytopathic hypoxia as a potential cause for multiorgan system dysfunction in sepsis may direct efforts t... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452626 Wed, 31 Mar 2010 23:00:00 +0100 3452626 http://www.medworm.com/index.php?rid=3452625&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000047%2Fabstract%3Frss%3Dyes Despite improvements in resuscitation and treatment of sepsis, the morbidity and mortality remain unacceptably high. Microvascular dysfunction has been shown to play a significant role in the pathogenesis of sepsis and is a potential new target in the management of sepsis. Clinical studies, aided by new techniques that allow for real-time assessment of the microcirculation, have shown that disturbances in microcirculatory flow are common in sepsis and correlate with worse outcomes. Bedside measurement of microcirculatory perfusion has become simpler and more accessible, and may provide key insights into prognosis in sepsis and guide future therapeutics, much like mean arterial pressure (MAP), lactate, and mixed central oxygen saturation (SvO2) do now. The authors review here the role of mi... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452625 Wed, 31 Mar 2010 23:00:00 +0100 3452625 http://www.medworm.com/index.php?rid=3452624&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001274%2Fabstract%3Frss%3Dyes This article reviews use of partial carbon dioxide rebreathing devices to determine cardiac output and their application for hemodynamic monitoring in the ICU and operating room. The primary focus is on the NICO monitoring device. Compared with conventional cardiac output methods, these techniques are noninvasive, easily automated, and provide real-time and continuous cardiac output monitoring. The advantages and limitations of each technique are different discussed. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452624 Wed, 31 Mar 2010 23:00:00 +0100 3452624 http://www.medworm.com/index.php?rid=3452623&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000023%2Fabstract%3Frss%3Dyes This article presents national and international competency statements regarding critical care echocardiography and training resources for intensivists. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452623 Wed, 31 Mar 2010 23:00:00 +0100 3452623 http://www.medworm.com/index.php?rid=3452622&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000059%2Fabstract%3Frss%3Dyes This article discusses the invasive and noninvasive techniques to assess cardiac output. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452622 Wed, 31 Mar 2010 23:00:00 +0100 3452622 http://www.medworm.com/index.php?rid=3452621&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000035%2Fabstract%3Frss%3Dyes This article addresses the numerous problems that surround the use and consequences of blood transfusion, such as hemoglobin and hematocrit levels, oxygenation, storage time, immunomodulation, infection, and anemia. The relevant literature is comprehensively reviewed. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452621 Wed, 31 Mar 2010 23:00:00 +0100 3452621 http://www.medworm.com/index.php?rid=3452620&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001316%2Fabstract%3Frss%3Dyes Global tissue hypoxia is one of the most important factors in the development of multisystem organ dysfunction. In hemodynamically unstable critically ill patients, central venous oxygen saturation (Scvo2) and mixed venous oxygen saturation (Svo2) monitoring has been shown to be a better indicator of global tissue hypoxia than vital signs and other clinical parameters alone. Svo2 is probably more representative of global tissue oxygenation, whereas Scvo2, is less invasive. Svo2 and Scvo2 monitoring can have diagnostic and therapeutic uses in understanding the efficacy of interventions in treating critically ill, hemodynamically unstable patients. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452620 Wed, 31 Mar 2010 23:00:00 +0100 3452620 http://www.medworm.com/index.php?rid=3452619&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001298%2Fabstract%3Frss%3Dyes This article explores dynamic means of determining preload responsiveness. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452619 Wed, 31 Mar 2010 23:00:00 +0100 3452619 http://www.medworm.com/index.php?rid=3452618&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS074907040900133X%2Fabstract%3Frss%3Dyes This article focuses on static methods for determining preload, specifically pressure and volumetric indices measured at the bedside. The underlying ventricular function will determine where the patient is located on Frank-Starling ventricular function curve and the patient's response to a fluid challenge. The proper interpretation and use of such measures, coupled with an understanding of their limitations and knowledge of alternative methods, is necessary to guide properly volume resuscitation in the critically ill. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452618 Wed, 31 Mar 2010 23:00:00 +0100 3452618 http://www.medworm.com/index.php?rid=3452617&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001304%2Fabstract%3Frss%3Dyes This article focuses on the mean arterial pressure goals during sepsis, the measurement of the mean arterial pressure, and the manipulation of this target with volume resuscitation and pharmacologic interventions. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452617 Wed, 31 Mar 2010 23:00:00 +0100 3452617 http://www.medworm.com/index.php?rid=3452616&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001328%2Fabstract%3Frss%3Dyes Lactic acidosis is a common condition encountered by critical care providers. Elevated lactate and decreased lactate clearance are important for prognostication. Not all lactate in the intensive care unit is due to tissue hypoxia or ischemia and other sources should be evaluated. Lactate, in and of itself, is unlikely to be harmful and is a preferred fuel for many cells. Treatment of lactic acidosis continues to be aimed the underlying source. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452616 Wed, 31 Mar 2010 23:00:00 +0100 3452616 http://www.medworm.com/index.php?rid=3452615&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001286%2Fabstract%3Frss%3Dyes This article examines the relationship of oxygen delivery to oxygen use under varying conditions. Topics reviewed include the concept of the critical dissolved oxygen, concerns over shared measurement errors in obtaining estimates of oxygen consumption, seminal articles in this area, and the practice of early goal directed therapy. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452615 Wed, 31 Mar 2010 23:00:00 +0100 3452615 http://www.medworm.com/index.php?rid=3452614&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000060%2Fabstract%3Frss%3Dyes From the early recognition of altered hemodynamics in severe sepsis and septic shock, practitioners have sought new and improved ways to optimize convective oxygen transport, to establish important end points for resuscitation, and to assess the effect of various interventions on organ function and survival. In this regard, investigations of animal models of sepsis have provided unequivocal support for the central role of hemodynamics in determining outcome. Unfortunately, the human experience has been checkered with positive and negative trials, providing clinicians with little certainty about how best to proceed when faced with patients suffering from severe sepsis and septic shock. Notwithstanding The Surviving Sepsis Campaign's endorsement of early goal-directed therapy, targets such a... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452614 Wed, 31 Mar 2010 23:00:00 +0100 3452614 http://www.medworm.com/index.php?rid=3452613&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000138%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452613 Wed, 31 Mar 2010 23:00:00 +0100 3452613 http://www.medworm.com/index.php?rid=3452612&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000126%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452612 Wed, 31 Mar 2010 23:00:00 +0100 3452612 http://www.medworm.com/index.php?rid=3452611&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070410000114%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3452611 Wed, 31 Mar 2010 23:00:00 +0100 3452611 http://www.medworm.com/index.php?rid=3033013&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001201%2Fabstract%3Frss%3Dyes (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3033013 Fri, 27 Nov 2009 15:46:35 +0100 3033013 http://www.medworm.com/index.php?rid=3033012&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409001067%2Fabstract%3Frss%3Dyes This article discusses end-of-life issues in critically ill cancer patients. Since the majority of deaths will occur after limiting or withdrawing life support, focus should be given to ensuring that multidisciplinary family meetings are convened to discuss end-of-life decision making. Throughout the process of transitioning from cure to comfort care, it is essential to support the patient and the patient's family cultural beliefs and spiritual values, and to ensure good pain and symptom management. The use of protocols facilitates a smooth transition and potentially reduces variability between health care providers. Integrating measures into the ICU routine that will help health care providers cope with the care of a dying patient is recommended to avoid moral distress or emotional burnou... Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3033012 Fri, 27 Nov 2009 15:46:35 +0100 3033012 http://www.medworm.com/index.php?rid=3033011&cid=s_33218_53_f&fid=33218&url=http%3A%2F%2Fwww.criticalcare.theclinics.com%2Farticle%2FPIIS0749070409000761%2Fabstract%3Frss%3Dyes This article describes the initiation and role development of our collaborative physician-NP critical care medicine (CCM) program at the Memorial Sloan-Kettering Cancer Center. The challenges that our program encountered with recruiting, training, transitioning, collaborating, communicating, and addressing end-of-life issues are detailed in this article. Finally, we delve into the emotional impact NPs have on this new role and propose future directions to strengthen the CCM NP model. We hope that this descriptive article of the development of our CCM NP group will allow others who are seeking to cultivate their own CCM NP teams to benefit from our experience. (Source: Critical Care Clinics) Critical Care Clinics journals http://www.medworm.com/rss/comments.php?id=3033011 Fri, 27 Nov 2009 15:46:35 +0100 3033011