Journal of intensive care medicine
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J Intensive Care Med · Mar 2005
Review Case ReportsDexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients.
Dexmedetomidine (Precedex, Abbott Laboratories, Abbott Park, IL) is an alpha 2 adrenergic agonist that possesses a high ratio of specificity for the alpha 2 versus the alpha 1 receptor. It is currently approved for the provision of sedation during mechanical ventilation in adults. ⋯ The authors present their experience with the use of dexmedetomidine to control withdrawal behavior in 3 patients following cardiothoracic surgery. Previous reports regarding the use of dexmedetomidine to treat withdrawal and its potential application in this clinical arena are reviewed.
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J Intensive Care Med · Mar 2005
Review Comparative StudyUse of cellular and plasma apheresis in the critically ill patient: Part II: Clinical indications and applications.
Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. ⋯ The choice of plasma or cellular apheresis in these cases is guided by well-accepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.