Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Apr 2013
Cognitive impairment after critical illness: etiologies, risk factors, and future directions.
Mortality rates have declined substantially among critically ill populations in recent years, resulting in increasing numbers of individuals with significant physical, cognitive, and psychiatric morbidities due to the effects of their illness. A consensus has begun to develop regarding the nature of the difficulties experienced by intensive care unit (ICU) survivors, including physical, cognitive, and psychiatric decrements. This article focuses primarily on wide-ranging aspects of cognition and discusses potential mechanisms, risk factors, and recovery and rehabilitation of post-ICU cognitive impairment.
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Semin Respir Crit Care Med · Apr 2013
Reflecting on use of the GRADE process for development of the 2013 PAD Guidelines.
This article evaluates the methodology used to develop the updated American College of Critical Care Medicine/Society of Critical Care Medicine Pain Agitation and Delirium (PAD) Guidelines in terms of (1) evaluating the role of a medical librarian in the guidelines development process; (2) summarizing the impressions of the guideline task force members on the use of Grades of Recommendation, Assessment, Development, and Evaluation and anonymous voting to develop guideline questions, statements, and recommendations; and (3) analyzing the impact of this approach to developing clinical practice guidelines on interrater reliability in evaluating evidence, statements, and recommendations.
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Semin Respir Crit Care Med · Apr 2013
Pharmacological management of sedation and delirium in mechanically ventilated ICU patients: remaining evidence gaps and controversies.
Although pharmacotherapy remains the mainstay for the prevention and treatment of pain, anxiety, and delirium (PAD) in the intensive care unit (ICU), many of the PAD-related medications currently used may lead to unintended consequences, particularly when these agents are administered at excessive doses for prolonged periods. The method by which these medications are administered and titrated is increasingly being recognized as potentially affecting patient outcomes as much as the drug itself. ⋯ The recently published American College of Critical Care Medicine (ACCM) Pain, Agitation, and Delirium Clinical Practice Guidelines provide 12 medication-related recommendations surrounding the prevention and treatment of PAD. This paper (1) provides the ICU bedside clinician with more background on the most important, and in some cases most contentious and challenging areas, of sedation and delirium pharmacotherapy in the critical care setting; (2) provides an update on the most recent evidence surrounding the prevention and treatment of agitation and delirium in ICU; and (3) highlights areas that require further investigation and provide practical strategies by which to apply current evidence in this area to daily ICU practice.
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With 1.4 million deaths in 2011 and 8.7 million new cases, tuberculosis (TB) disease remains a global scourge. Global targets for reductions in the epidemiological burden of TB have been set for 2015 and 2050 within the context of the Millennium Development Goals (MDGs) and by the Stop TB Partnership. Achieving these targets is the focus of national and international efforts in TB control, and demonstrating whether or not they are achieved is of major importance to guide future and sustainable investments. This paper discusses the methods used to estimate the global burden of TB; estimates of incidence, prevalence, and mortality for 2011, combined with assessment of progress toward the 2015 targets for reductions in these indicators based on trends since 1990 and projections up to 2015; trends in TB notifications and in the implementation of the Stop TB Strategy; and prospects for elimination of TB by 2050.