Clinics in chest medicine
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This article reviews the current understanding of sepsis, severe sepsis, and septic shock. The article details definitions and epidemiology pertinent to the sepsis syndrome. A brief discussion of mechanisms of disease is followed a description of organ-specific failures related to sepsis. A concise review of the latest treatment options for each organ dysfunction is provided.
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Clinics in chest medicine · Mar 2009
ReviewSedation and analgesia for the mechanically ventilated patient.
Mechanically ventilated patients in the intensive care unit routinely require sedative and analgesic medications to manage pain and anxiety. These medications may have unpredictable effects with long-term use. Strategies that may help to improve patient outcomes include thoughtful selection of medications, use of objective sedation and pain scales, and implementation of protocolized sedation.
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Disorders of hemostasis and thrombosis are frequently encountered in the ICU setting. Understanding the relevance of laboratory findings is essential in providing appropriate therapy. ⋯ Appropriate use of these agents maximizes therapeutic effect while minimizing complications. Use of fresh frozen plasma, cryoprecipitate, and other hemostatic agents should generally be reserved for those who have active bleeding, those undergoing invasive procedures, and those at high risk for bleeding because of their underlying diagnoses or because of associated hematologic derangements.
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Survival of patients presenting with acute liver failure (ALF) has improved because of earlier disease recognition, better understanding of pathophysiology of various insults leading to ALF, and advances in supportive measures including a team approach, better ICU care, and liver transplantation. This article focuses on patient management and evaluation that takes place in the ICU for patients who have acute liver injury. An organized team approach to decision making about critical care delivered during this period of time is important for achieving a good patient outcome.
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A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. ⋯ Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.