Critical care clinics
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Critical care clinics · Jul 2003
ReviewPediatric cardiopulmonary-cerebral resuscitation: an overview and future directions.
The evolving understanding of pathophysiologic events during and after pediatric cardiac arrest has not yet resulted in significantly improved outcome. Exciting breakthroughs in basic and applied science laboratories are, however, on the immediate horizon for study in specific subpopulations of cardiac arrest victims. Strategically focusing therapies to specific phases of cardiac arrest and resuscitation and evolving pathophysiologic events offers great promise that critical care interventions will lead the way to more successful cardiopulmonary and cerebral resuscitation in children.
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Continuous renal replacement therapy is an effective means for fluid and solute management in ARF/MOSF. Prospective studies have examined issues of anticoagulation, the impact of replacement/dialysis, the effects of bicarbonate-versus lactate-based solutions, and nutritional and medication clearance. ⋯ The authors, examining the issues as an intensivist and as a nephrologist, believe that early institution, aggressive replacement/dialysis, and use of citrate-based replacement fluids provide substantive advantages. With the advent of Ronco's recent data on sepsis managed with filtration and plasma absorption, the indication for use of CRRT in MOSF may become more evident regardless of the presence or absence of ARF.
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In pediatric trauma care, many long-held tenets of management have been revised. This article reviews the latest advances in pediatric trauma care, particularly in the areas of resuscitation and management of thoracic and abdominal injuries. The final topic is a discussion of what the intensivist and surgeon must know when caring for the pediatric victim of terrorist attacks.
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The delivery of critical care in the emergency department is a growing challenge that faces emergency physicians and intensivists. As emergency departments and intensive care units become increasingly crowded, critically ill patients will remain in the emergency department for longer periods of time. The care provided for critically ill patients during the emergency department stay significantly decreases the progression of organ failure and mortality. ⋯ As critical care requires significant resources including time from physicians and nurses, as well as physical resources including space, monitoring equipment, and medications, improving the quality of critical care delivery in the emergency department is not without obstacles. Resources are not limitless and the true goal is finding the point where delivering the best patient care possible occurs within the available resources of the emergency department and the hospital. This article describes the current status of critical care in the emergency department and discusses possible strategies for improvement.
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The management of patients for end-stage liver disease in the ICU mandates a multidisciplinary approach and intense monitoring. Orthotopic liver transplantation still remains the only definitive therapy. ⋯ In recent years, considerable progress has been made in developing specific and supportive medical measures. Future research should target a better understanding of mechanisms responsible for liver cell death and liver regeneration, as well as developments in xenotransplantation, hepatocyte transplantation, and liver-directed gene therapy.