Clinics in chest medicine
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Targeted temperature management has an established role in treating the post-cardiac arrest syndrome after out-of-hospital cardiac arrest with an initial rhythm of ventricular tachycardia/ventricular fibrillation. There is less certain benefit if the initial rhythm is pulseless electrical activity/asystole or for in-hospital cardiac arrest. Targeted temperature management may have a role as salvage modality for conditions causing intracranial hypertension, such as traumatic brain injury, hepatic encephalopathy, intracerebral hemorrhage, and acute stroke. There is variable evidence for its use early in these disorders to minimize secondary neurologic injury.
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Clinics in chest medicine · Sep 2015
ReviewManagement of Infections with Drug-Resistant Organisms in Critical Care: An Ongoing Battle.
Infections with multidrug-resistant organisms (MDROs) are common in critically ill patients and are challenging to manage appropriately. Strategies that can be used in the treatment of MDRO infections in the intensive care unit (ICU) include combination therapy, adjunctive aerosolized therapy, and optimization of pharmacokinetics with higher doses or extended-infusion therapy as appropriate. Rapid diagnostic tests could assist in improving timely appropriate antimicrobial therapy for MDRO infections in the ICU.
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Recent research has identified promising targets for therapeutic interventions aimed at modulating the inflammatory response in sepsis. Herein, the authors describe mechanisms involved in the clearance of pathogen toxin from the circulation and potential interventions aimed at enhancing clearance mechanisms. The authors also describe advances in the understanding of the innate immune response as potential therapeutic targets. Finally, novel potential treatment strategies aimed at decreasing vascular leak are discussed.
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During the last 15 years, critical care services provided via telemedicine have expanded to now be incorporated into the care of 13% of patients in intensive care units (ICUs) in the United States. A response to shortfalls in the availability of critical care-trained providers has evolved into integrated programs of ICU care with contributions to improved outcomes through proactive management, population oversight, and standardization of care processes. The most impactful characteristics of successful ICU telemedicine programs are now better understood with more than a decade of national experience and the accrued benefits to health care systems.
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Clinics in chest medicine · Sep 2015
ReviewManagement of Right Heart Failure in the Intensive Care Unit.
Right heart failure is a clinical syndrome of various causes that commonly involves failure of the right ventricle (RV). The hemodynamic hallmark of the syndrome is increasing central venous pressure and worsening cardiac output with a rising RV end-diastolic pressure. When dealing with RV failure, clinicians must assess and optimize the intravascular volume state, support RV contractility, and address any pathologic elevations of afterload so that systemic perfusion is preserved. Despite these measures, there may still be a need to offer rescue interventions to the failing RV in carefully selected patients.