Current opinion in critical care
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Evidence supporting dedicated intensivist staffing in intensive care units is growing. Despite clinical and economic benefits, medical staff politics and a shortage of intensivists impede the intensivist model. The purpose of this paper is to accelerate patient's exposure to the benefits of intensivists, and introduce team care in the intensive care unit. ⋯ Intensivists save lives and costs. By working toward team care, hospitals may achieve a successful intensivist model, and patients may realize the benefits of spending less for healthcare and living longer. To achieve this model, physician and hospital leaders must form a partnership.
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Curr Opin Crit Care · Dec 2006
ReviewFailure of nonoperative management of abdominal solid organ injuries.
Nonoperative management of the spleen has been the conventional approach for dealing with blunt splenic injury in children for 25 years. Following acceptance in the field of pediatric surgery, nonoperative management of blunt injury to the liver and spleen became the template in adult trauma surgery. It has proven to be of unequivocal benefit to the majority of hemodynamically stable pediatric and adult patients who have suffered blunt liver or splenic trauma. Offsetting these gains, has been the presence of failures. ⋯ Despite the failures of nonoperative management outlined in this review, the approach has been generally successful. Efforts at improving organ salvage rates and diminishing failures with this approach continue. Notwithstanding our enthusiasm to advance this method of patient care, we must avoid imperiling a subpopulation of patients in our attempt to improve nonoperative management success rates.
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Curr Opin Crit Care · Dec 2006
ReviewThe perspective of families of the critically ill patient: their needs.
An appreciation of a family's difficult experience in dealing with their critically ill loved ones has created the concept of 'family-centered care'. The purpose of this paper is to review the literature on the needs of the family during their intensive care unit experience. ⋯ Medical staff and administrators should recognize that families of critically ill patients have particular needs that help them cope with having their loved ones in an intensive care unit. Simple changes in philosophy and policy would greatly decrease the anxiety these families experience.
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Acute renal failure is a common complication of sepsis in the critically ill patient. Fluid resuscitation is considered a cornerstone for preservation of function in the septic kidney. This is generally based on the assumption that fluid therapy will restore and maintain adequate renal blood flow. ⋯ Thus, it remains unclear how fluid therapy may affect renal blood flow in septic acute renal failure. Further, there is new evidence to imply that the choice, timing and amount of fluid used for resuscitation in sepsis may have a direct impact on kidney function. Thus, in this editorial, we consider the relevant literature and more recent insights into the effect of fluid resuscitation on the septic kidney.