Critical care clinics
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Pulmonary embolism (PE) is a common diagnosis in critical care. Depending on the severity of clot burden, the clinical picture ranges from nearly asymptomatic to cardiovascular collapse. The signs and symptoms of PE are nonspecific. ⋯ Submassive PE remains the most challenging with regard to initial and long-term management. Little consensus exists as to the appropriate tests for risk stratification and therapy. This article reviews the current literature and a suggested approach to these patients.
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Managing patients after heart transplantation is challenging, since these patients have unique clinical complications (associated with the immunosuppressive therapy and cardiac allograft rejection) together with atypical clinical presentations for infection and systemic inflammatory response syndrome. Survival rates have improved substantially with the use of new immunosuppressive drugs. High vigilance, early diagnosis, and appropriate intervention for allograft-related and non-allograft-related syndromes with significant morbidity and mortality are the keys to long-term survival of patients after transplantation.
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Right ventricular failure complicates several commonly encountered conditions in the intensive care unit. Right ventricular dilation and paradoxic movement of the interventricular septum on echocardiography establishes the diagnosis. ⋯ Principles of treatment focus on reversal of the underlying cause, optimization of right ventricular preload and contractility, and reduction of right ventricular afterload. Mechanical support with right ventricular assist device or veno-arterial extracorporeal membrane oxygenation can be used in select patients who fail to improve with optimal medical therapy.
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Critical care clinics · Jul 2014
ReviewPerioperative Complications of Cardiac Surgery and Postoperative Care.
The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion.
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Critical care clinics · Jul 2014
ReviewHemodynamic Assessment in the Contemporary Intensive Care Unit: A Review of Circulatory Monitoring Devices.
The assessment of the circulating volume and efficiency of tissue perfusion is necessary in the management of critically ill patients. The controversy surrounding pulmonary artery catheterization has led to a new wave of minimally invasive hemodynamic monitoring technologies, including echocardiographic and Doppler imaging, pulse wave analysis, and bioimpedance. This article reviews the principles, advantages, and limitations of these technologies and the clinical contexts in which they may be clinically useful.