Critical care clinics
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Critical care clinics · Oct 2018
ReviewThe Pathophysiology of Neuromuscular Dysfunction in Critical Illness.
Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. ⋯ This represents a significant burgeoning public health concern. This article presents a brief overview of the pathophysiology and the emerging basic science of neuromuscular dysfunction in critical illness.
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Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. ⋯ Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs.
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Intensive care unit (ICU)-acquired weakness frequently complicates critical illness, which prolongs intensive care dependency and causes long-term burden. Observational studies have suggested that prolonged underfeeding could aggravate ICU-acquired weakness and impair outcome. ⋯ Moreover, early parenteral nutrition was even shown to increase ICU-acquired weakness and prolong organ failure and intensive care dependency, which may be explained by feeding-induced suppression of autophagy. Currently, the ideal timing of artificial nutrition for critically ill patients as well as the optimal dose and composition remain unclear.
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Critical care clinics · Oct 2018
ReviewSedation, Delirium, and Cognitive Function After Critical Illness.
Delirium has been consistently identified as a risk factor for critical illness brain injury, but ICU patients are exposed to a multitude of risk factors for delirium and it remains unclear which of these risk factors should be targeted to improve long-term cognitive outcomes. Because exposure to sedating medications-which are frequently used to treat unwanted yet common symptoms during critical illness-is a risk factor for delirium that is directly controlled by clinicians, the relationship between sedation, delirium, and long-term cognition is of great interest to clinicians, researchers, and patients. This review describes theoretic relationships between sedation, delirium, and long-term cognition and reviews the evidence supporting these theoretic relationships.
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Critical care clinics · Oct 2018
ReviewPreventing Chronic Critical Illness and Rehospitalization: A Focus on Sepsis.
An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital admission with in 90 days, most commonly for infection. Treatment should focus on preventing the common sequelae of critical illness during the initial hospitalization, tailoring medical care to minimize the risk for common and potentially preventable causes of hospital readmission, and promoting functional recovery.