Journal of intensive care medicine
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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.
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J Intensive Care Med · Jul 2012
Consent for donation after cardiac death: a survey of organ procurement organizations.
Despite the increasing number of policies governing organ donation after cardiac death (DCD), nothing is presently known about the informed consent process for DCD. Without guidelines, organ procurement organizations (OPOs) are likely to structure the consent process similarly to that for organ donation after brain death (DBD), despite important ethical differences between the 2 modes of organ recovery. ⋯ None of the OPOs responding to this survey have a policy requirement for physician involvement in obtaining consent for DCD. These findings raise questions about the role of physicians in DCD and how best to maintain a patient- and family-centered focus on care for patients at the end of life while supporting organ recovery efforts.
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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.