Journal of intensive care medicine
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J Intensive Care Med · Sep 2012
Mortality of patients with respiratory insufficiency and adult respiratory distress syndrome after surgery: the obesity paradox.
Obesity has long been considered a risk factor for the development of various pathologies, yet evidence supporting increased risk of perioperative mortality in obese individuals developing postoperative complications is limited. Therefore, we sought to characterize the demographics of obese and nonobese individuals developing postoperative respiratory insufficiency (RI)/adult respiratory distress syndrome (ARDS) and to quantify the impact of obesity on in-hospital mortality among this patient population utilizing data collected for the Nationwide Inpatient Sample (NIS). ⋯ In our analysis, obesity was associated with a decreased incidence and adjusted odds for in-hospital mortality after surgery. Our results support the emerging concept of the "obesity paradox."
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J Intensive Care Med · Sep 2012
ReviewInternet-based learning and applications for critical care medicine.
Recent changes in duty hour allowances and economic constraints are forcing a paradigm shift in graduate medical education in the United States. Internet-based learning is a rapidly growing component of postgraduate medical education, including the field of critical care medicine. Here, we define the key concepts of Internet-based learning, summarize the current literature, and describe how Internet-based learning may be uniquely suited for the critical care provider. ⋯ Internet-based learning may provide an opportunity for assistance in the transformation of medical education. Many features of Web-based learning, including interactivity, make it advantageous for the adult medical learner, especially in the field of critical care medicine, and further work is necessary to develop a robust learning platform incorporating a variety of learning modalities for critical care providers.
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J Intensive Care Med · Sep 2012
ReviewFever in the critically ill: a review of epidemiology, immunology, and management.
Fever is common among patients admitted to intensive care units (ICUs). In spite of the frequency of its occurrence, the biological mechanisms regulating the initiation and progression of fever are poorly understood. In addition, there are few large studies reporting on the epidemiology and etiology of fever in general medical and surgical ICU patients. ⋯ The decision to treat fever should therefore be obvious, but several lines of evidence argue against temperature-lowering strategies. Furthermore, the use of different temperature control strategies in febrile patients without acute brain injury or acute myocardial infarction is guided by a paucity of randomized clinical trials and by a lack of understanding of the biology of the induction and control of fever. As such, a review of the epidemiology, molecular mechanisms, and immunology of fever as well as the evidence behind management of fever in the critically ill is pertinent to all critical care practitioners.
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This review provides an update on the pharmacology of airway management, emphasizing medications and management strategies widely used in an intensive care unit setting. Induction agents, muscle relaxants, opioids, sedative-hypnotics, and adjunctive agents are reviewed in the context of emergent airway management. Throughout this review, we emphasize the utility of considering a broad set of pharmacologic agents and approaches for airway management of the critically ill patient.