Critical care clinics
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Critical care clinics · Jan 2001
ReviewCytopathic hypoxia. Mitochondrial dysfunction as mechanism contributing to organ dysfunction in sepsis.
Several lines of evidence support the notion that cellular energetics are deranged in sepsis, not on the basis of inadequate tissue perfusion, but rather on the basis of impaired mitochondrial respiration and/or coupling; that is, organ dysfunction in sepsis may occur on the basis of cytopathic hypoxia. If this concept is correct, then the therapeutic implications are enormous. Efforts to improve outcome in patients with sepsis by monitoring and manipulating cardiac output, systemic Do2, and regional blood flow are doomed to failure. Instead, the focus should be on developing pharmacologic strategies to restore normal mitochondrial function and cellular energetics.
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The future of cardiopulmonary resuscitation lies in new technologies for monitoring and generating vital organ perfusion during cardiac arrest and the post-resuscitation phase and in pharmacologic agents that will enhance ROSC and reverse ischemia-reperfusion injury. ROSC is the first step toward survival, so interventions that improve ROSC deserve further investigation. ⋯ The resources required to provide many of the interventions discussed in this article, principally invasive perfusion technologies, cannot be justified unless there is clear benefit. The allocation of such resources to provide intensive resuscitation and post-resuscitation support will need to be addressed from medical and societal viewpoints.
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The last few decades of the 20th century were marked by tremendous advances in diagnostic imaging and related therapeutic procedures. The new millennium holds great promise for more spectacular advances. Continuing evolution of computer technology coupled with existing and evolving digital imaging platforms will serve as a catalyst for significant developments in virtually all areas of imaging. This report surveys the potential of these advances in areas relevant to critical care.
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Technological advances in critical care will undoubtedly find their way into the ICU of the 21st century. The challenge for critical care practitioners is to meticulously assess these innovations and adopt the most appropriate and efficient technologies that will improve unit function and staff efficiencies, support educational programs, and most importantly, enhance patient outcome at a reasonable cost. ⋯ The authors' experience has left them with the lasting impression that the evaluation and introduction of new technology is time consuming and requires perseverance and patience. Ultimately, it is hoped that technological breakthroughs coupled with a standardized approach to delivery of ICU services in the coming decades will ensure better and more efficient care to critically ill patients.
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The physical design of most ICUs is a source of inadvertent and undesirable stress for patients, family, and staff. The importance of developing a healing environment will have a great impact on the ICU bedside environment of the future. Using the research on the effects of noise, light, and other environmental stressors on patient outcomes, the ICU bedside environments of the future will combine the "high tech" and "high touch" components of care in one setting. The patients and the care providers will benefit from this focus on the humane, healing environment.