Current opinion in critical care
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Curr Opin Crit Care · Dec 2012
ReviewStructure and function: planning a new ICU to optimize patient care.
To survey the recent medical literature reporting effects of ICU design on patients' and family members' well being, safety and functionality. ⋯ An organization structured on the needs of the patient and their family is mandatory in designing a new ICU. The main aims in the design of a new department should be patient-centered care, safety, functionality, innovation and a future-proof concept.
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There is still an ongoing debate whether damage control orthopedics (DCO) or other treatment strategies should be favored in the treatment of multiply injured patients. This review gives an overview of the current literature concerning this important question in the treatment of severely injured patients. ⋯ In severely injured patients, DCO should be considered. On the other hand, there is still a lack of randomized studies for a more precise characterization of the patients who benefit from DCO treatment.
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Curr Opin Crit Care · Dec 2012
ReviewProtocoled resuscitation and the prevention of acute kidney injury.
Acute kidney injury (AKI) occurrence in critically ill patients is common and is associated with a substantial increase in morbidity and mortality. The scope of this review is to summarize the most recent evidence-based knowledge for prevention of AKI. ⋯ Key components of optimal AKI prevention include maintenance of renal perfusion and avoidance of precipitating factors. Adequate renal blood flow maintenance is the first strategy to employ not only to assure renal oxygenation, but also to prevent nephrotoxic drugs-associated AKI. Many potential therapies and interventions are on the horizon, but most of the future research will need to focus more on a step-wise, protocoled, kidney-oriented approach, than on single treatments.
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Recent high-profile campaigns have endeavoured to improve the quality of critical care provision. Within other specialities, integrated care pathways (ICPs) have been advocated as an effective means of improving practice. We review the published research regarding their efficacy and potential role in critical care. ⋯ ICPs show promise as a mechanism for improving efficiency and care quality in specific circumstances. However, little research specific to critical care has been undertaken and it may be challenging to protocolize the multisystem care required in many critical illnesses. Although further evaluation is required to find the most appropriate way of incorporating ICPs into critical care, we commend their thoughtful adoption.
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Trauma-induced coagulopathy is a frequent complication in severely injured patients. To correct coagulopathy and restore haemostasis, these patients have traditionally been treated with fresh frozen plasma, but in the last decade, there has been a shift from empirical therapy to targeted therapy with coagulation factor concentrates and other haemostatic agents. This review highlights emerging therapeutic options and controversial topics. ⋯ Current evidence in trauma resuscitation indicates a potential role for coagulation factor concentrates and other haemostatic agents in correcting trauma-induced coagulopathy. Despite a shift towards such transfusion strategy, there remains a shortage of data to support this approach.