Critical care clinics
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Critical care clinics · Jul 1986
ReviewPulmonary sequelae and lung repair in survivors of the adult respiratory distress syndrome.
The high in-hospital mortality of ARDS has not diminished over the past 10 years, despite improvements in supportive intensive care. Much of the mortality arises from infections, particularly sepsis and pneumonia, and from organ failure, especially kidney failure. The rapid advances in understanding the interlocking pathophysiologic mechanisms of ARDS have not yet been translated into therapeutic trials of new methods for diminishing the injury or for stimulating normal repair. ⋯ More information about the long-term pathologic course, though difficult to obtain, would also be very important. Perhaps some registry of ARDS survivors would permit closer follow-up and make available more late autopsy pathology when these people die of other causes. The rapid time course of ARDS provides an ideal testing ground for agents designed to either decrease lung injury or stimulate repair.(ABSTRACT TRUNCATED AT 400 WORDS)
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A large body of experimental data indicates that blood flows during CPR because of elevations of intrathoracic pressure and the uneven peripheral transmission of this pressure. Data from humans are less extensive, but also strongly support the mechanism of intrathoracic pressure. It should be remembered that the intrathoracic pressure and direct cardiac compression hypotheses are not mutually exclusive, and that effective CPR is above all dependent on vigorous chest compression. ⋯ These data demonstrate that CPR is an effective means of supporting the circulation during cardiac arrest. The majority of survivors return to a meaningful existence, and the technique has not burdened society with a large load of neurologically impaired patients. Thus, CPR is very much worthy of the full attention and support of the medical community.
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Critical care clinics · Apr 1986
ReviewAbdominal binding and counterpulsation in cardiopulmonary resuscitation.
During the past 15 years, many different studies have documented improved blood pressure and blood flow above the diaphragm when some type of abdominal compression was added to conventional CPR, either in animals or in humans. Rhythmically interposed abdominal compressions seem to provide even greater hemodynamic benefit than continuous abdominal binding. ⋯ It requires no special equipment, and could be easily incorporated into existing training programs for basic rescuers. In this sense the technique may constitute a logical evolution in basic life support, if subsequent clinical research confirms that it improves outcome.
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Increasingly, the ethics of resource allocation is becoming one of the most critical ethical problems faced by critical care decision makers; what is lacking is a framework for analyzing the ethics of decisions in resource allocation. This article examines the four ethical principles--patient-centered beneficence, autonomy, full beneficence, and justice--that can contribute to cost containment/resource allocation.
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Burnout may be one of the most common problems affecting critical care physicians. Burnout can best be defined as disillusionment and a flattening of the effervescence of life. Recognizing the symptoms of burnout and the sources of stress enables one to incorporate preventive strategies and self-rescue techniques.