Journal of critical care
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Journal of critical care · Aug 2014
Observational StudyIncidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients.
Atrial fibrillation (AF) is thought to be a relatively common arrhythmia in the setting of noncardiac intensive care unit (ICU). However, data concerning AF deriving from such populations are scarce. In addition, it is unclear which of the wide spectrum of AF predictors are relevant to the ICU setting. ⋯ A significant fraction of ICU patients manifest AF. The predictors of interest for the ICU patients might be considerably different than those of the general population and other subgroups with systemic inflammation possibly having a pivotal role.
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Journal of critical care · Aug 2014
Influence of abdominal obesity on multiorgan dysfunction and mortality in acute respiratory distress syndrome patients treated with prone positioning.
Obesity is a worldwide pandemic, and obese patients face an increased risk of developing acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a frequently used intervention in the treatment of ARDS. There are no data describing the impact of PP on morbidity and mortality in abdominally obese patients. We report our observations in abdominally obese ARDS patients treated with PP. ⋯ A cautious approach to PP should be considered in abdominally obese patients.
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Journal of critical care · Aug 2014
EditorialBiophilosophical basis for identifying the death of a person.
The capacity for consciousness and self-awareness is uniquely synonymous with human life and personhood, and its absence is necessary and sufficient to identify that death has occurred. The presence of these functions is uniquely synonymous with human life. Ongoing organ function, response to infection, growth, wound healing, or the ability to sustain an unborn fetus do not alone constitute the unique experience of life and personhood. ⋯ Progressive hypoxia that is seen in many patients after withdrawal of advanced physiologic support leads to apnea and then circulatory arrest. The outward sign of apnea that is then followed by circulatory arrest is the basis for inferring that irreversible loss of capacity for consciousness and self-awareness has occurred and that death can be identified has having occurred. The capacity for consciousness and self-awareness is the only irreplaceable emergent phenomenon—arising from physiologic function of the brain—that is necessary and sufficient to define the life of a person.
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Journal of critical care · Aug 2014
ReviewAutomated pupillometer for monitoring the critically ill patient: A critical appraisal.
Abnormalities in the pupillary light reflex are an important prognostic indicator for patients in the intensive care unit (ICU). Manual pupillary examination is confounded by interobserver discrepancies and errors in detecting a reflex under certain conditions. The automated pupillometer is a computer-based infrared digital video device that can obtain objective measurements of pupillary size and reactivity. ⋯ Pupillometric measurements had better precision and reproducibility compared with the manual pupillary examination. Based on these data, we conclude that pupillometry monitoring can serve as an important tool in the ICU. Further large scale studies on patients in the neurocritical care unit and medical ICU are needed to support the routine use of automated pupillometry.