Current opinion in critical care
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Curr Opin Crit Care · Aug 2014
ReviewPerioperative haemodynamic management: is echocardiography the right tool?
This review analyses the application of perioperative echocardiography as an important tool in the management of haemodynamic impairment. ⋯ Echocardiography has recently gained popularity among anaesthesiologists and intensive care practitioners because it provides a pathophysiological picture of haemodynamic impairment, allowing a more detailed understanding of the static or dynamic parameters on which clinicians usually rely when making decisions.
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Curr Opin Crit Care · Aug 2014
ReviewOptimal fluid resuscitation in trauma: type, timing, and total.
This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. ⋯ During the resuscitation of the acutely injured patient, crystalloids should be limited in favor of blood components. Damage control principles apply until definitive hemostasis is obtained, at which point the focus should change to targeted resuscitation using traditional global endpoints of resuscitation in conjunction with determinants of regional perfusion.
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Curr Opin Crit Care · Aug 2014
ReviewIntravenous fluids in traumatic brain injury: what's the solution?
Intravenous fluid is a fundamental component of trauma care and fluid management influences patient outcomes. This narrative review appraises recent clinical studies of fluid therapy in patients with traumatic brain injury (TBI), with respect to its use in volume resuscitation and prevention of secondary injury. ⋯ In patients with TBI, intravenous fluids are integral to management; they may be both a source of harm and a potential therapy to limit secondary brain injury. They should be prescribed in accordance with other pharmaceutical or therapeutic interventions. Refined usage may improve patient outcomes.
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Curr Opin Crit Care · Aug 2014
ReviewPulmonary complications in patients receiving a solid-organ transplant.
Major improvements in perioperative care and immunobiology have not abated the risk for severe pulmonary complications after solid-organ transplantation. The aim of this study is to update information on infectious and noninfectious pulmonary complications after solid-organ transplantation, addressing epidemiology, risk factors, diagnostic workup, and management. ⋯ Pulmonary complications after solid-organ transplantation, and particularly infections, are able to compromise the extremely good results of the transplant procedures. Solid-organ transplantation recipients challenge the ICU physician with unique aspects of their post-transplant course, adding, in an already critical patient, the immunosuppressed state and the quality of the functional recovery of the graft.
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Early acute respiratory distress syndrome (ARDS) is characterized by protein-rich inflammatory lung edema often associated with a hydrostatic component. Mechanical ventilation with positive intrathoracic pressure further induces salt and water retention, while impairing the pathways designed for edema clearance. In this framework, we will review the recent findings on fluid strategy and edema clearance in ARDS. ⋯ Lung edema is likely the single pathogenic factor more relevant for ARDS severity and outcome. Fluid overload must be avoided. Several monitoring techniques are available to reach this target. No specific studies are available to recommend a given fluid composition in ARDS. In our opinion, the general recommendations for fluid composition suggested for severe sepsis and septic shock should be applied to ARDS that may be considered an organ-confined sepsis.