Current opinion in critical care
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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.
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This review summarizes novel information regarding the role of metabolic control in the perioperative period. ⋯ Minimizing the effects of insulin resistance has been shown to substantially improve outcome after surgical stress.
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Curr Opin Crit Care · Aug 2005
ReviewPotential mechanisms and markers of critical illness-associated cognitive dysfunction.
To review the current understanding of the potential mechanisms of critical illness-associated cognitive dysfunction and to provide insight into markers that could be used to evaluate the influence of specific mechanisms in individual patients. ⋯ Although recent advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed to provide a better understanding of the relative contribution of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Curr Opin Crit Care · Aug 2005
ReviewOrganizational characteristics and the quality of surgical care.
Public recognition of wide variations in surgical outcomes has prompted numerous efforts aimed at measuring and improving quality. Given that many of the most prominent efforts focus on organizational factors, this paper reviews the growing body of evidence underlying these initiatives. ⋯ Several organizational characteristics are strongly related outcomes for critically ill surgical patients. Increasing the number of surgical patients receiving care in hospitals adhering to these organizational practices would save many lives each year.