Journal of intensive care medicine
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J Intensive Care Med · Mar 2012
Sleep deprivation in critical illness: its role in physical and psychological recovery.
Critically ill patients frequently experience poor sleep, characterized by frequent disruptions, loss of circadian rhythms, and a paucity of time spent in restorative sleep stages. Factors that are associated with sleep disruption in the intensive care unit (ICU) include patient-ventilator dysynchrony, medications, patient care interactions, and environmental noise and light. ⋯ This review article summarizes the literature regarding sleep architecture and measurement in the critically ill, causes of ICU sleep fragmentation, and potential implications of ICU-related sleep disruption on patients' recovery from critical illness. With this background information, strategies to optimize sleep in the ICU are also discussed.
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J Intensive Care Med · Mar 2012
Case ReportsRapid rewarming of hypothermic patient using arctic sun device.
There are multiple commercially made devices currently available for inducing hypothermia in patients with postcardiac arrest, but whether these devices can be used successfully for rewarming patients suffering from accidental hypothermia remains largely unexplored. We describe a case in which a patient with severe accidental hypothermia secondary to environmental exposure was successfully, safely, and rapidly warmed using a temperature regulation device traditionally used for therapeutic hypothermia (TH) in patients with postcardiac arrest. Clinicians may wish to consider the use of these devices when attempting to warm patients suffering from severe environmental hypothermia.
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J Intensive Care Med · Mar 2012
The acute effectiveness and safety of the constant-flow, pressure-volume curve to improve hypoxemia in acute lung injury.
To investigate the effectiveness of the constant-flow, pressure-volume curve (PVC) to prescribe positive end-expiratory pressure (PEEP) in acute lung injury (ALI) and risk of cardiopulmonary deterioration during the PVC process. ⋯ In the setting of acute lung injury, use of the constant-flow, pressure-volume curve to prescribe PEEP appears associated with improvement in oxygenation with limited risk of acute, process-related, cardiopulmonary deterioration.
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Early recognition and differentiation of shock, as well as goal-directed resuscitation, are fundamental principles in the care of the critically ill or injured patient. Substantial progress has been made over the last decade in the understanding of both shock and resuscitation. ⋯ These include the optimal targets for perfusion pressure and oxygen delivery, endpoints of resuscitation, resuscitative fluid, and transfusion strategies for packed red blood cells and blood products. This article reviews the diagnosis and differentiation of shock, measurements of tissue perfusion, current evidence regarding various resuscitative techniques, and complications of resuscitation.