Journal of critical care
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Journal of critical care · Dec 2016
ReviewRecirculation in venovenous extracorporeal membrane oxygenation.
Despite the increasing use of venovenous extracorporeal membrane oxygenation (ECMO) to treat severe respiratory failure, recirculation remains a common complication that may result in severe hypoxemia and end-organ damage. The present review, therefore, examines updated evidence for the causes, measurement, and management of recirculation. Six electronic databases were searched from their dates of inception to January 2016, and 38 relevant studies were selected for analysis. ⋯ Although cannula configuration appears to be a key contributor to recirculation in addition to factors such as ECMO flow rate, there are insufficient comparative clinical studies to recommend an optimal cannulation technique for minimizing recirculation. Existing evidence suggests that the dual-lumen cannula may have a low recirculation fraction, but only if correctly positioned. This review underscores the need for more robust clinical and laboratory studies to effectively evaluate and address the persistent problem of recirculation.
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Journal of critical care · Dec 2016
ReviewThe role of central venous oxygen saturation, blood lactate, and central venous-to-arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment.
The current practice in treatment of severe sepsis and septic shock is to ensure adequate oxygenation and perfusion in patients, along with prompt administration of antibiotics, within 6 hours from diagnosis, which is considered the "golden hour" for the patients. One of the goals of treatment is to restore normal tissue perfusion. With this goal in mind, some parameters have been used to determine the success of treatment and mortality rate; however, none has been proven to be the best predictor of mortality rate in sepsis patients. Despite growing evidence regarding the prognostic indicators for mortality in sepsis patients, inconsistent reports exist. ⋯ There is currently no ideal biomarker that can indicate prognosis, predict progression of the disease, and guide treatment in sepsis. Further studies are needed to be carried out to identify the ideal biomarker that has all the desired properties.
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Respiratory failure is among the most common primary causes of or complications of critical illness, and although mechanical ventilation can be lifesaving, it also engenders substantial risk of morbidity and mortality to patients. Three decades of research suggests that the duration of invasive mechanical ventilation can be reduced substantially, reducing morbidity and mortality. Mean duration of ventilation reported in recent international studies suggests a quality chasm in management of this common critical illness. ⋯ To the extent that daily wake-up-and-breathe reduces morbidity, mortality, and length of stay, failure to deploy this strategy is, by definition, malpractice (ie, poor practice). Practical measures are offered to close this quality chasm.
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Journal of critical care · Dec 2016
ReviewAntiepileptic dosing for critically ill adult patients receiving renal replacement therapy.
The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). ⋯ Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.
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Journal of critical care · Oct 2016
ReviewHow is life support withdrawn in intensive care units: A narrative review.
Decisions to withdraw life-sustaining therapy (WDLS) are relatively common in intensive care units across Canada. As part of preliminary work to develop guidelines for WDLS, we performed a narrative review of the literature to identify published studies of WDLS. ⋯ This review describes current practices and opinions about WDLS, and also demonstrates the significant practice variation that currently exists. We believe that the development of guidelines to help increase transparency and standardize the process will be an important step to ensuring high quality care during WDLS.