Current opinion in critical care
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Curr Opin Crit Care · Dec 2014
ReviewApproaches to patients and families with strong religious beliefs regarding end-of-life care.
End-of-life (EOL) decisions with limitations are made daily in ICUs around the world and may involve between 2 and 22% of patients admitted to an ICU. EOL decisions may be affected by numerous factors, including location and religion. This review aims to determine an approach to patients and families with strong religious views. ⋯ Through proper open communication and understanding of the patient's and/or family's views on EOL care and involvement of religious leaders, decisions can be made regarding how to further care for the patient.
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Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings. ⋯ An algorithm-based approach to airway management can prevent complications due to inadequate oxygenation or procedural difficulties in trauma patients; therefore, advanced equipment for handling a difficult airway is needed. After securing the airway, ventilation must be monitored by capnography, and normoventilation involving the early use of protective ventilation with low-tidal volume and moderate positive end-expiratory pressure must be the target. After early identification of patients with blunt chest trauma at risk for respiratory failure, noninvasive ventilation might be a treatment strategy, which should be evaluated in future research.
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Curr Opin Crit Care · Dec 2014
ReviewContrast-associated AKI in the critically ill: relevant or irrelevant?
Iodinated contrast media are frequently administered in ICU patients. Recent studies challenge the relevance of contrast media toxicity in ICU patients and relate occurrence of acute kidney injury to baseline characteristics and severity of illness. ⋯ There are diverse pathophysiologic mechanisms explaining the causal relationship between the administration of contrast media and the development of acute kidney injury. Some studies challenge the relevance of contrast media toxicity in ICU patients. However, limitations of the available studies in ICU patients preclude firm conclusions. A precautionary approach in the administration of contrast media is justified.
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Curr Opin Crit Care · Dec 2014
ReviewRecent developments in the assessment of the multiply injured trauma patient.
To provide an update on the recent developments and controversies in the assessment of the traumatically injured patient. ⋯ The recent advances in the assessment of the multiply injured patient allow clinicians to more efficiently diagnose a patient's injuries and implement treatment in a more timely manner.
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Acute kidney injury (AKI) is a frequent and serious event associated with a high rate of complications, with an increased risk of progression to multiple organ dysfunction and excessive 'attributable' mortality. AKI affects all physiologic functions and organ systems with interrelated mechanisms, including the 'classical' consequences of the uremic state, the inflammatory nature of AKI per se and resulting systemic effects, the modulating effect of AKI in the presence of an (inflammatory) underlying disease process and the multiple untoward effects induced by renal replacement therapy (RRT) and anticoagulation. ⋯ These systemic phenomena associated with AKI induce distant organ injury affecting all organ systems with clinically the most relevant effects being exerted on the lungs, the intestines and liver and the heart and predispose the progression to multiple organ dysfunction syndrome and death. Currently available renal replacement therapy modalities are incapable of compensating for these systemic consequences of AKI.