Current opinion in critical care
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The review focuses on severe acute vaso-occlusive manifestations of sickle cell disease leading adult patients to the ICU. ⋯ Acute vaso-occlusive episodes are characterized by an unpredictable course that needs for vigilance for everyone, and justifies ICU or intermediate care unit admission to allow close monitoring, and supportive treatment in a timely fashion.
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Curr Opin Crit Care · Dec 2015
Quality measures for acute kidney injury and continuous renal replacement therapy.
Quality and safety are important priorities in the care of critically ill patients. For patients with acute kidney injury (AKI) or for those receiving continuous renal replacement therapy (CRRT), measures and outcomes associated with quality of care have been suboptimally developed and evaluated. The review is timely as it summarizes current quality practices in AKI and CRRT, and presents ongoing and future developments. ⋯ Few studies have examined the quality of care provided to patients with AKI and CRRT. Evidence suggests opportunities to improve the quality of care received by patients at risk of or who have developed AKI. Priorities for improving quality of care exist across several important themes including risk identification, diagnosis, monitoring, investigation, and strategies for management. Similarly, evidence-informed quality measures of CRRT care have not been rigorously evaluated. These are important knowledge-to-care gaps that require further investigation.
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Thrombocytopenia and heparin exposure are common in critically ill patients, yet immune heparin-induced thrombocytopenia (HIT), a prothrombotic adverse effect of heparin, rarely accounts for thrombocytopenia in this patient population. The review discusses the clinical and laboratory features that distinguish HIT from non-HIT thrombocytopenia. ⋯ Greater understanding of the various clinical and laboratory features that distinguish HIT from non-HIT thrombocytopenia could help improve outcomes in patients who develop thrombocytopenia and coagulopathies in the ICU.
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Acute kidney injury (AKI) is a common problem in critically ill patients, with long-term health implications that extend beyond hospital discharge. Though they are at a high risk of adverse events, AKI survivors may not be receiving adequate postdischarge medical attention. This review discusses recently published data regarding health outcomes after AKI, the current state of post-AKI care, and potential opportunities to improve outpatient care after AKI. ⋯ AKI is associated with a number of long-term health effects, and new strategies may be needed to address this emerging public health issue. An ambulatory program dedicated to the postdischarge care of AKI survivors may confer a variety of benefits. Future research is needed to evaluate this model of care.
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Curr Opin Crit Care · Dec 2015
ReviewNutritional controversies in critical care: revisiting enteral glutamine during critical illness and injury.
This article examines some of the articles that inspired recent changes to critical care guidelines related to glutamine in enteral nutrition. ⋯ Recent studies suggest that enteral glutamine supplementation may not provide significant clinical benefits to adult patients on mechanical ventilation with multiple organ failure, but more information is still needed when attempting to apply these results to other groups of critical care patients.