Current opinion in critical care
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Curr Opin Crit Care · Aug 2005
ReviewRecent developments in percutaneous tracheostomy: improving techniques and expanding roles.
The purpose of this review is to provide an update of recent developments pertaining to the use of percutaneous tracheostomy. Percutaneous tracheostomy has been established as an alternative to open surgical tracheostomy, but many key questions about the optimal use of this procedure remain unanswered. ⋯ Recent literature suggests that percutaneous tracheostomy is safe to use in an expanding population of patients, including patients with airway compromise and thrombocytopenia. Several methods seem to be safe alternatives to that originally described. Capnography has arisen as an alternative to bronchoscopy for confirmation of tracheal puncture. Recent evidence highlights that although tracheostomy may improve short-term outcome, these critically ill patients have a significant long-term risk of poor outcome. This must be taken into consideration when this procedure is offered.
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Curr Opin Crit Care · Aug 2005
ReviewLung transplantation: donor and recipient critical care aspects.
The purpose of this paper is to highlight new developments in donor and recipient lung transplant issues for the critical care physician. ⋯ Patients undergoing lung transplantation continue to be very challenging in the intensive care unit. A multidisciplinary approach to care, and early recognition of serious problems, will help improve outcomes.
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Curr Opin Crit Care · Aug 2005
ReviewGlycemic and nonglycemic effects of insulin: how do they contribute to a better outcome of critical illness?
This review gives an overview of the clinical outcome benefits associated with intensive insulin therapy administered to critically ill patients and of the progress in the unraveling of the mechanisms underlying these positive effects. ⋯ Substantial progress has been made in the understanding of the mechanisms underlying the improved survival and reduced morbidity with intensive insulin therapy in critical illness. More studies, however, are needed to further elucidate the exact pathways involved and the relative contribution of prevention of glucose toxicity and direct nonglycemic effects of insulin.
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Curr Opin Crit Care · Aug 2005
ReviewRecent advances in the surgical management of necrotizing pancreatitis.
To summarize advances and new concepts in the surgical management of necrotizing pancreatitis published within the past year with emphasis on the evolving importance of the recognition of abdominal compartment syndrome as a significant contributor to early development of organ failure. ⋯ Recent studies confirm the overall validity of the established surgical principles for necrotizing pancreatitis: delayed necrosectomy in patients with infected peripancreatic necrosis, mostly nonoperative management of sterile necrosis, and delayed cholecystectomy in severe gallstone-associated pancreatitis. The role of abdominal compartment syndrome as an important contributing factor to early development of multiple organ failure and the potential benefit of surgical decompression are gaining support from recent reports and should be carefully assessed in future studies.
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This review will set forth the new consensus definitions for intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome from the World Congress on the Abdominal Compartment Syndrome in December 2004. The review will explore the challenges in diagnosis, pathophysiology, and recent concepts in the treatment of abdominal compartment syndrome. ⋯ Massive resuscitation is increasingly recognized as a major contributor to abdominal compartment syndrome. Prophylactic decompression and temporary abdominal closure have important roles in preventing tertiary or recurrent abdominal compartment syndrome. Failure to recognize and treat intra-abdominal hypertension will result in increased risk of renal impairment, visceral and intestinal ischemia, respiratory failure and death.