Journal of critical care
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Journal of critical care · Apr 2016
ReviewBarbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials.
To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS). ⋯ Although the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.
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Journal of critical care · Apr 2016
ReviewSurvival benefits of dexmedetomidine used for sedating septic patients in intensive care setting: A systematic review.
The aim of this systematic review was to evaluate the effectiveness and safety of dexmedetomidine used for sedation of patients with sepsis. ⋯ In a small group of studies of patients with sepsis, dexmedetomidine improved short-term mortality compared with other sedatives without affecting the intensive care unit length of stay. Further studies are warranted to confirm whether using this particular agent improves sepsis outcomes in comparison to other commonly used sedating agents.
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Journal of critical care · Feb 2016
ReviewThoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review.
The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for the physiotherapist and could be routinely performed at patients' bedsides to provide real-time and accurate information on the status of pleura, lungs, and diaphragm; this would allow for assessment of lung aeration from interstitial syndrome to lung consolidation with much better accuracy than chest x-rays or auscultation. ⋯ This narrative review refers to lung and diaphragm ultrasound semiology and describes how physiotherapists could use this tool in their clinical decision-making processes in various cases of respiratory disorders. The use of thoracic ultrasound semiology alongside typical examinations may allow for the guiding, monitoring, and evaluating of chest physiotherapy treatments. Thoracic ultrasound is a potential new tool for physiotherapists.
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Journal of critical care · Feb 2016
ReviewDevelopment of a fluid resuscitation protocol using inferior vena cava and lung ultrasound.
Appropriate fluid resuscitation has been a major focus of critical care medicine since its inception. Currently, the most accurate method to guide fluid administration decisions uses "dynamic" measures that estimate the change in cardiac output that would occur in response to a fluid bolus. Unfortunately, their use remains limited due to required technical expertise, costly equipment, or applicability in only a subset of patients. ⋯ Common POCUS applications that serve as guides to fluid administration rely on assessments of the inferior vena cava to estimate preload and lung ultrasound to identify the early presence of extravascular lung water and avoid fluid overresuscitation. Although application of these POCUS measures has multiple limitations that are commonly misunderstood, current evidence suggests that they can be used in combination to sort patients among 3 fluid management categories: (1) fluid resuscitate, (2) fluid test, and (3) fluid restrict. This article reviews the pertinent literature describing the use of inferior vena cava and lung ultrasound for fluid responsiveness and presents an evidence-informed algorithm using these measures to guide fluid resuscitation decisions in the critically ill.
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Journal of critical care · Feb 2016
Review Case ReportsLife after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature.
Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern recently described in the literature with fewer than 120 cases published. AFOP is often difficult to diagnose and may be mistaken for other pulmonary disorders such as interstitial pneumonias or pneumonitides. Patients often present with vague symptoms of cough, dyspnea, hemoptysis, fatigue, and occasionally respiratory failure. ⋯ We will describe the presentation, diagnosis, and post-discharge course, and review the current literature. There are only 4 cases which have reported the patients' course of disease after 1 year, the longest being 2 years. To our knowledge, this is the only case of AFOP in the literature that describes the course of a patient more than 2 years after the diagnosis of AFOP, and is the most comprehensive review of the current literature.