Journal of critical care
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Hypernatremia is common in intensive care units. It has detrimental effects on various physiologic functions and was shown to be an independent risk factor for increased mortality in critically ill patients. Mechanisms of hypernatremia include sodium gain and/or loss of free water and can be discriminated by clinical assessment and urine electrolyte analysis. ⋯ Therefore, the intensivists should be very careful to provide the adequate sodium and water balance for them. Hypernatremia is treated by the administration of free water and/or diuretics, which promote renal excretion of sodium. The rate of correction is critical and must be adjusted to the rapidity of the development of hypernatremia.
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Journal of critical care · Apr 2013
Energy expenditure in patients with severe head injury: controlled normothermia with sedation and neuromuscular blockade.
Providing optimal caloric intake is important for patients with severe traumatic brain injury. Insufficient nutrition worsens prognosis, and excessive nutrition may lead to complications such as weaning delay from mechanical ventilation. However, using controlled normothermia with sedation and neuromuscular blockade for patients with anticipated severe brain edema, the optimal caloric intake is still unclear. ⋯ Energy expenditure in patients with severe traumatic brain injury who need mechanical ventilation and have received controlled normothermia with sedation and neuromuscular blockade was 13% less than predicted basal levels. Energy expenditure might be obtained from age, body height, body weight, heart rate, and minute ventilation.
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Journal of critical care · Apr 2013
Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients.
The purpose of this study was to investigate the impact of large-volume thoracentesis (>1000 mL) on transpulmonary thermodilution (TPTD)-derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI). ⋯ Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.
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Journal of critical care · Apr 2013
ReviewHyponatremia in critical care patients: frequency, outcome, characteristics, and treatment with the vasopressin V2-receptor antagonist tolvaptan.
Hyponatremia is a common problem in critical care patients and is associated with increased duration of hospital stay and increased morbidity and mortality. The prevalence of hyponatremia in the intensive care unit (ICU) has been reported to be as high as 30% to 40%. Recent studies have found hyponatremia at ICU admission in up to 14% of patients in unselected groups; patients with hyponatremia were at elevated risk of mortality vs normonatremic patients. ⋯ Tolvaptan treatment increases serum sodium via aquaresis-ie, increased electrolyte-free water excretion-and thus presents an advantage in patients with syndrome of inappropriate secretion of antidiuretic hormone or other euvolemic states or hypervolemic hyponatremia. This article provides a review of hyponatremia and of the potential use of tolvaptan in critical care settings. Case reports provide examples of tolvaptan use in correcting severe hyponatremia and associated abnormal mental status and in resolving hyponatremia prior to surgery.
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Journal of critical care · Apr 2013
Effectiveness of sepsis bundle application in cirrhotic patients with septic shock: a single-center experience.
To evaluate the effect of adherence to evidence-based guidelines of the Surviving Sepsis Campaign (SSC) on the outcome of cirrhotic patients with septic shock admitted to the intensive care unit. ⋯ In our observational study, the adherence to the interventions recommended by the SSC evidence-based guidelines did not provide an improvement in the survival rate of cirrhotic patients with septic shock.