Journal of intensive care medicine
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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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J Intensive Care Med · Jul 2012
ReviewVariability in the determination of death after cardiac arrest: a review of guidelines and statements.
The reemergence of organ donation after circulatory determination of death (DCDD) in Canada demands the establishment of clear, evidence-based guidelines for the determination of death. The primary purpose of this study was to investigate the variability in specific criteria, diagnostic tests, and recommended wait periods for the determination of death after cardiac arrest. ⋯ This review is the first to document the variability of guidelines and statements for the determination of death after cardiac arrest, in countries where the practice of DCDD is becoming increasingly common. The scarcity of peer-reviewed published guidelines in the medical literature exemplifies the need for further investigation. We believe these results will inform the ethical discussions surrounding the determination of death after cardiac arrest. Clear and consistent guidelines based on evidence are needed to fulfill medical, ethical, and legal obligation and to ensure public trust.
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J Intensive Care Med · Jul 2012
ReviewDexmedetomidine and clonidine: from second- to first-line sedative agents in the critical care setting?
In the critical care setting, α-2 agonists present a multifaceted profile: sedation combined with arousability, suppression of delirium, preservation of respiratory drive, reduced O(2) consumption, preserved renal function, and reduced protein metabolism. In addition, this review details the reduced arterial impedance, improved left ventricular performance, preserved vascular reactivity to exogenous amines, preserved cardiac baroreflex reactivity, preserved vasomotor baroreflex activity combined with a lowered pressure set point: these features may explain the good tolerance observed when α-2 agonists are used as continuous infusion without any loading dose. Reviewing the literature allows one to suggest that a new management appears possible with arousable sedation. ⋯ Should such a speculative view be confirmed, then α-2 agonists will move from second-line sedative agents to first-line sedative agents. However, key studies are lacking to demonstrate the effect of α-2 agonists on physiological endpoints and outcome. Presently, the existing body of data suggests a niche for the use of α-2 agonists in the critical care setting.
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J Intensive Care Med · Jul 2012
ReviewHyponatremia and the use of vasopressin receptor antagonists in critically ill patients.
Hyponatremia in critically ill patients is a common and challenging problem. Increased levels of arginine vasopressin almost always contribute to the etiology. ⋯ No data are available on the use of vaptans in acute hyponatremia, and they are not indicated in hypovolemic hyponatremia. The focus of this review is the treatment of critically ill patients with hyponatremia with vaptans and other measures.
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J Intensive Care Med · May 2012
ReviewNorepinephrine or dopamine for septic shock: systematic review of randomized clinical trials.
There is debate as to the vasopressor agent of choice in patients with septic shock. According to current guidelines either dopamine or norepinephrine may be considered as the first-line agent for the management of refractory hypotension of septic shock. ⋯ The analysis of the pooled studies that included a critically ill population with shock predominantly secondary to sepsis showed superiority of norepinephrine over dopamine for in-hospital or 28-day mortality.