Critical care clinics
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Closed loop control of mechanical ventilation is routine and operates behind the ventilator interface. Reducing caregiver interactions is neither an advantage for the patient or the staff. Automated systems causing lack of situational awareness of the intensive care unit are a concern. ⋯ Alert notifications for sudden escalation of therapy are required to ensure patient safety. Automated ventilation is useful in remote settings in the absence of experts. Whether automated ventilation will be accepted in large academic medical centers remains to be seen.
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Critical care clinics · Jul 2018
ReviewChallenges and Future Directions in Left Ventricular Assist Device Therapy.
The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers. Appropriate patient selection remains key to optimal LVAD outcomes.
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Critical care airway management is associated with a variety of complications, including severe oxygen desaturation, life-threatening hypotension, and death. This article reviews aspects of airway management that are relevant to intensivists and emergency medicine clinicians tasked with improving the quality of urgent endotracheal intubation in the critically ill patient.
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Critical care clinics · Jul 2018
ReviewPrevention and Treatment of Right Ventricular Failure During Left Ventricular Assist Device Therapy.
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. ⋯ However, RV failure may also develop due to unanticipated intraoperative or perioperative factors. Early recognition and treatment are critical in terms of mitigating the impact of RV failure on post-LVAD outcomes.
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Critical care clinics · Jul 2018
ReviewComplications of Durable Left Ventricular Assist Device Therapy.
Heart failure patients on durable left ventricular assist device support experience improved survival, quality of life, and exercise capacity. The complication rate, however, remains unacceptably high, although it has declined with improvements in pump design, better patient selection, and greater understanding of the pump physiology and flow dynamics. Most complications are categorized as those related to the pump-patient interface or those related to patient physiology. It is hoped that further engineering progress, and better patient selection through risk stratification, will allow for left ventricular assist device to be totally biocompatible and perform effectively, without affecting biology and homeostasis of the different organ systems.