Current opinion in critical care
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Curr Opin Crit Care · Dec 2012
ReviewClinical Reflection: a vital process for supporting the development of wisdom in doctors.
This review explores in detail the practice of reflection and its importance for doctors. It offers a definition of and a framework for both oral and written Clinical Reflection. It presents a thorough and detailed explanation of Clinical Reflection, its meaning, purpose, and processes and provides an illustrative case example from critical care. ⋯ Clinical Reflection offers doctors a powerful way of supporting their professional development and providing evidence of their practical wisdom as expressed by Aristotle. It is time that an appropriate understanding of what reflection can offer doctors is explored more generally among the profession.
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Acute kidney injury (AKI) is a clinical syndrome with many different causes. The Kidney Disease: Improving Global Outcomes consensus AKI definition has harmonized the study of AKI, yet effective clinical therapeutics are not available to treat most cases of AKI. In order to develop therapeutic interventions, an approach to AKI that subdivides the various causes of AKI into well codified subclasses of AKI may allow a process of 'disentanglement'. ⋯ Disentangling the AKI syndrome requires an approach of rigorous taxonomy, molecular diagnostics, and intense collaboration. This approach may be applied to other complex and heterogeneous syndromes like sepsis and acute respiratory distress syndrome as well, but this article only outlines this approach to AKI.
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Acute kidney injury (AKI) in the ICU is associated with adverse outcomes. We review the long-term consequences of AKI in ICU patients. ⋯ Further research is necessary to delineate the mechanisms by which AKI may lead to CKD, and to understand how CKD enhances the risk for developing AKI. Whereas restrospective observational studies of this population exist, prospective clinical studies and trials evaluating the long-term clinical outcomes of AKI specifically in ICU patients are needed.
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Curr Opin Crit Care · Dec 2012
ReviewResuscitation and transfusion management in trauma patients: emerging concepts.
Severe trauma is associated with hemorrhage, coagulopathy and transfusion of blood and blood products, all associated with considerable mortality and morbidity. The aim of this review is to focus on resuscitation, transfusion strategies and the management of bleeding in trauma as well as to emphasize on why coagulation has to be monitored closely and to discuss the rationale of modern and future transfusion strategies. ⋯ Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions and thereby optimizes the patient's coagulation, reduces the exposure to blood products, reduces costs and may improve clinical outcome.
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Curr Opin Crit Care · Dec 2012
ReviewCare of the critically ill patient with advanced chronic kidney disease or end-stage renal disease.
The number of individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is rising, and these individuals often require intensive care. ⋯ Despite the manifest physiologic derangements attending CKD/ESRD, a higher burden of comorbid conditions and a greater severity of illness on presentation account for much of the increased mortality. There is no justification for therapeutic nihilism in this population.