Current opinion in critical care
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Curr Opin Crit Care · Dec 2014
ReviewRenal disease presenting as acute kidney injury: the diagnostic conundrum on the intensive care unit.
Acute kidney injury (AKI) is commonplace in most ICUs. In many cases the cause is believed to be multifactorial with sepsis being a major component. However, occasionally intrinsic renal disease will present to the ICU and as such critical care practitioners should be aware of this possibility and the ways in which such conditions may present. ⋯ Not all AKI as described by changes in creatinine and urine output which presents or develops on the ICU is the same. AKI is a syndrome which encompasses many conditions and as such is nondiagnostic. Clinicians, when faced with AKI should satisfy themselves as to the likely cause of the AKI.
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To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients. ⋯ Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.
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Although providing palliative care in the ICU has become a priority, the success of different methods to integrate palliative care into the ICU has varied. This review examines the current evidence supporting the different models of palliative care delivery and highlights areas for future study. ⋯ Developing a mixed model of palliative care delivery is necessary to meet the palliative care needs of critically ill patients. Efforts focused on improving integrative models and appropriately targeting the use of palliative care consultants are needed.
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Advance care planning and palliative care interventions can improve the quality of end-of-life care by reducing unwanted high intensity care at the end of life. This may have important economic implications and may reduce the financial burden of patients' families. We review the literature to examine the impact advance care planning and palliative care has on ICU utilization, specifically ICU admissions and ICU length of stay (LOS), and to provide insight into ways to reduce costs and financial burden of care while simultaneously improving quality of care. ⋯ Advance care planning and palliative care can reduce ICU utilization at the end of life. The degree to which reducing ICU utilization decreases emotional and financial burden of end-of-life care for patients and families is unknown.
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Mortality from trauma remains a global public health challenge, with most preventable deaths due to bleeding. The recognition of acute traumatic coagulopathy as a distinct clinical entity characterized by early coagulation dysfunction, arising prior to medical intervention, has revolutionized trauma management over the last decade. The aim of this article is to review our current understanding of acute traumatic coagulopathy. ⋯ Emphasis is now placed on early prevention, diagnosis, and aggressive initial treatment of coagulopathy and fibrinolysis with haemostatic blood products and tranexamic acid in addition to red cell units in order to reduce bleeding and improve clinical outcomes.