Critical care clinics
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Critical care clinics · Apr 2022
ReviewRapid Exome and Genome Sequencing in the Intensive Care Unit.
Rapid genomic sequencing has become a powerful diagnostic tool for critically ill children. Accumulated data support clinical utility. ⋯ Cost savings to health care institutions are not only the result of reduced sequencing charges (which have paralleled advances in sequencing technology), but also and more specifically have impact on diagnosis-specific medical management and reduced length of hospitalization. The use of genomic sequencing in critical care is still primarily limited to academic centers but will ultimately become the wider-spread standard of care for select patients.
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Acute kidney injury (AKI) is one of the most important complications of critical illness and a significant public health concern. AKI is commonly associated with sepsis, cardiac dysfunction, and exposure to nephrotoxic medication; however, less common causes of AKI can lead to devastating patient outcomes when the underlying diagnosis is missed or delayed. These uncommon causes of AKI fall into 3 large categories: structural, immune mediated, and microvascular, including various types of thrombotic microangiopathy. Kidney imaging, urine studies, and serum hemolytic studies should be a routine part of the evaluation of AKI among critically ill patients.
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The focus of this narrative review is the differential diagnosis of disease involving the peripheral or lower motor neuron component of the neurology of breathing. The clinical context is limited to those conditions leading to admission to the intensive care unit with a time course often described as acute or of rapid onset, meaning within days to weeks. However, the article also reviews those underlying inherited or congenital conditions that may have gone unnoticed until fulminant deterioration with respiratory failure.
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Pediatric acute liver failure is a rare process that results from many different diseases including toxin ingestion and drug overdose, infections, metabolic and genetic disorders, immune-mediated diseases, and ischemia. Up to 50% of children with acute liver failure will never have an underlying cause found. ⋯ Nonetheless, overall survival is approximately 50% without liver transplantation. Opportunities for improvement in the care of children with acute liver failure still exist.
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Critical care clinics · Apr 2022
ReviewUndiagnosed and Rare Diseases in Critical Care: Severe Mucocutaneous Medication Reactions.
There have been major advances in the understanding of severe cutaneous adverse reactions (SCARs). Early recognition and withdrawal of culprit medications can decrease morbidity and mortality significantly. ⋯ Physicians need to recognize SCARs early in their course, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis, and their mimicking conditions. This review focuses on common and rare SCARs with an emphasis on defining features, clinical and diagnostic evaluation, treatment, and long-term sequelae.