Journal of critical care
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Journal of critical care · Jun 2023
ReviewAvoiding brain hypoxia in severe traumatic brain injury in settings with limited resources - A pathophysiological guide.
Cerebral oxygenation represents the balance between oxygen delivery, consumption and utilization by the brain, and therefore reflects the adequacy of cerebral perfusion. Different factors can influence the amount of oxygen to the brain including arterial blood pressure, hemoglobin levels, systemic oxygenation, and transfer of oxygen from blood to the cerebral microcirculation. ⋯ Several tools have been proposed for the assessment of cerebral oxygenation, including non-invasive/invasive or indirect/direct methods, including Jugular Venous Oxygen Saturation (SjO2), Partial Brain Tissue Oxygen Tension (PtiO2), Near infrared spectroscopy (NIRS), Transcranial Doppler, electroencephalography and Computed Tomography. In this manuscript, we aim to review the pathophysiology of cerebral oxygenation, describe monitoring technics, and generate recommendations for avoiding brain hypoxia in settings with low availability of resources for direct brain oxygen monitoring.
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Journal of critical care · Jun 2023
ReviewDiabetes insipidus related to sedation in the intensive care unit: A review of the literature.
To identify cases of diabetes insipidus (DI) related to sedation in the ICU to determine which medications pose the greatest risk and understand patterns of presentation. ⋯ Awareness of the potential for sedatives to cause DI may lead to greater identification with swifter medication discontinuation and subsequent resolution of DI.
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We developed and validated two parsimonious algorithms to predict the time of diagnosis of any stage of acute kidney injury (any-AKI) or moderate-to-severe AKI in clinically actionable prediction windows. ⋯ The two AKI prediction models have good discriminative performance using common features, which can aid in accurately and informatively monitoring AKI risk in ICU patients.
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Journal of critical care · Jun 2023
Drug-related causes attributed to acute kidney injury and their documentation in intensive care patients.
To investigate drug-related causes attributed to acute kidney injury (DAKI) and their documentation in patients admitted to the Intensive Care Unit (ICU). ⋯ Drug-related causes comprise a substantial part of AKI in the ICU patients. However, current unstructured DAKI documentation practice via clinical notes hampers our ability to gain better insights about DAKI occurrence. Therefore, both automating DAKI identification from the clinical notes and increasing structured DAKI documentation should be encouraged.
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Journal of critical care · Jun 2023
Observational StudyHigh respiratory effort decreases splanchnic and peripheral perfusion in patients with respiratory failure during mechanical ventilation.
This study aimed to evaluate the effects of high respiratory effort(HRE) on spleen, kidney, intestine, and peripheral perfusion in patients with respiratory failure during mechanical ventilation. ⋯ HRE could decrease perfusion of peripheral tissues and splanchnic organs. The status of HRE should be avoided to protect splanchnic and peripheral organs in mechanically ventilated patients.