Ugeskrift for laeger
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The practice of paediatric intensive care has matured dramatically over the past 20 years with improving intensive care unit mortality rates and a positive effect on child survival. This paper gives an overview of many of these aspects, and attempts to present a picture of the present situation in Denmark. ⋯ In Denmark, critically ill children are cared for in at least 27 primarily adult intensive care units by nurses and doctors who are not specifically trained in paediatric intensive care. Suggestions for a more centralisation of paediatric intensive care in Denmark are made.
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Ugeskrift for laeger · Feb 2007
[Capacity in Danish intensive care units. A national survey of capacity, cancellations and transfers of critically ill patients].
A shortage of intensive care beds and fully-booked intensive care units has a range of undesirable consequences for patients and personnel, eg. transfer to other intensive care units, cancellation of operations, tighter visitation criteria and an increase in the work-load. The problem is illustrated in a national survey. ⋯ This survey documents that there is a problem with the capacity in Danish intensive care units. Establishing more intensive care beds in selected departments, ensuring personnel for the beds already established and establishing intermediate care beds could relieve the shortage of beds.
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Critical care research has facilitated the development of clinical guidelines to improve the outcome of critically-ill patients. The high mortality needs to be reduced further, by means of increased research to the benefit of patients, relatives and society. Clinicians, researchers, public officials and politicians at all levels must work together towards this aim.
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Acute renal failure (ARF) is characterized by a sudden increase in plasma creatinine and a decrease in urine flow. ARF is caused by multiple factors of which the most important are hypovolemia, hypotension, septic mediators and nephrotoxic agents. ARF is observed in 10-23% of critically ill patients. ⋯ If the patient survives, the recovery of renal function is 90-95%. Non-dialytic therapy is early volume resuscitation whereas furosemid may worsen ARF. At the present time the dialytic therapy of choice in ICU patients with ARF is continuous renal replacement therapy (CRRT).
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Critical illness is characterized by one or more failing organs. Hormonal regulation of metabolism changes during the course of critical illness and is related to the severity of disease. ⋯ Recent large scale insulin infusion studies have demonstrated beneficial effects on both the immune response and coagulation systems. Future research will show whether further hormonal substitution can reveal similar results.