Critical care clinics
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Carbon monoxide (CO) poisoning is the leading cause of death as a result of unintentional poisoning in the United States. CO toxicity is the result of a combination of tissue hypoxia-ischemia secondary to carboxyhemoglobin formation and direct CO-mediated damage at a cellular level. ⋯ Treatment consists of the patient's removal from the source of exposure and the immediate administration of 100% supplemental oxygen in addition to aggressive supportive measures. The use of hyperbaric oxygen is controversial.
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In this article, the authors review the current recommendations from the American Society for Apheresis regarding the use of plasmapheresis in many of the diseases that intensivists commonly encounter in critically ill patients. Recent experience indicates that therapeutic plasma exchange may be useful in a wide spectrum of illnesses characterized by microvascular thrombosis, the presence of autoantibodies, immune activation with dysregulation of immune response, and some infections.
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Critically ill patients are at increased risk for development of thrombosis. In addition, thrombosis is often unrecognized in this population. ⋯ Herein the authors review the pharmacology, data from clinical trials, management of bleeding complications, and perioperative use of these agents in the intensive care unit population. Well-designed clinical trials are needed to improve our understanding of the safety and efficacy of these newer agents in critically ill patients.
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Critical care clinics · Jul 2012
ReviewTransfusion reactions: newer concepts on the pathophysiology, incidence, treatment, and prevention of transfusion-related acute lung injury.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. ⋯ Recent studies have identified both recipient and transfusion risk factors for the development of TRALI. This article describes these TRALI risk factors, as well as diagnosis, treatment and prevention strategies.