Current opinion in critical care
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The publication of Van den Berghe's landmark study in 2001 supported the use of intensive insulin therapy (IIT) to target normoglycemia in the critically ill and triggered a new era in glycemic management in the perioperative period and in the ICU. In 2009, the normoglycemia in intensive care evaluation-survival using glucose algorithm regulation (NICE-SUGAR) trial demonstrated increased mortality and incidence of hypoglycemia in patients managed with IIT, resulting in a shift toward higher blood glucose targets in this patient population. This review distills clinically pertinent principles from the related literature published in the months since the NICE-SUGAR trial. ⋯ Appropriate glycemic management in the acute care setting can be achieved by targeting a reasonable blood glucose range and employing specific and institutionally validated IIPs.
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Curr Opin Crit Care · Aug 2011
ReviewProcedural sedation and analgesia in the emergency department.
Procedural sedation and analgesia is frequently administered outside of the operating room in emergency departments (EDs) and ICUs. Evidence was sought concerning patients' safety in the ED. ⋯ With appropriately trained personnel, proper equipment, and the studied drugs ED sedation and analgesia is safe and an appropriate procedure.
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Postoperative sepsis is a major cause of surgical associated morbidity and mortality. Our goal is to describe its incidence, pathophysiology, and contributing factors. In addition, we will review preventive measures and treatment options that may possibly reduce its healthcare burden. ⋯ The incidence of postoperative sepsis has not declined over the past years, although mortality is trending downwards. Several biochemical and genetic markers may allow early diagnosis. Prevention and prompt treatment may lower mortality.
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Curr Opin Crit Care · Aug 2011
ReviewNoninvasive hemodynamic monitoring in the emergency department.
Emergency department patients are frequently undifferentiated, need accurate risk assessment and stratification, and are time-critical in their need for diagnosis and resuscitation. Valid, noninvasive hemodynamic monitoring modalities are essential to differentiate high from low risk patients, and to perform goal-directed management. This review analyses recent literature, which describes innovation in the range of noninvasive monitoring tools and places them in the emergency medicine context. ⋯ Noninvasive measures of hemodynamic status and function are increasingly being used, although much still remains in the research domain. Noninvasive measures may not only offer similar variables to traditional vital signs, but add a new dimension of hemodynamic descriptors.