Current opinion in critical care
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To update critical care practitioners on the recent advancements in burn care. ⋯ This is a concise review of the recent burn literature tailored to the critical care practitioner. Criteria for extubation of burn patients are examined, as is the need for cuffed endotracheal tubes in pediatric burn patients. Strategies to avoid over-resuscitation are discussed, including use of colloid, as well as nurse-driven and computer-guided resuscitation protocols. New data regarding common ICU issues such as insulin therapy, delirium, and preferred intravenous access are reviewed. The importance of nutrition in the burn patient is emphasized, particularly early initiation of enteral nutrition, continuation of nutrition during surgical procedures, and use of adjuncts such as immunonutrition and beta blockade. Finally, both short-term and long-term wound issues are addressed via sections on laser Doppler assessment of burns and pressure garment therapy to prevent long-term scarring.
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Interest in the global burden of critical illness is growing, but comprehensive data to describe this burden and the resources available to provide care for critically ill patients are lacking. ⋯ Major unexplored research and public health questions remain unanswered regarding the worldwide burden of critical illness, variation in resources available for treatment, and strategies to prevent and treat critical illness that are broadly effective and feasible.
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Successful renal recovery is a key goal of patient management during acute kidney injury in critically ill patients. However, limited information exists to guide clinicians as to what interventions might either decrease or increase the likelihood of renal recovery and especially renal recovery to dialysis independence. The purpose of this review is to analyse recent data and help clinicians with relevant therapeutic choices. ⋯ Available evidence from randomized controlled trials and comparative analysis of their results as well as data from large observational studies suggest that the avoidance of IHD and of a positive fluid balance are likely to increase the speed of renal recovery and may prevent end-stage renal failure in selected high-risk patients with acute kidney injury.
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Systemic hypertension (HTN) is a common medical condition affecting over 1 billion people worldwide. One to two percent of patients with HTN develop acute elevations of blood pressure (hypertensive crises) that require medical treatment. However, only patients with true hypertensive emergencies require the immediate and controlled reduction of blood pressure with an intravenous antihypertensive agent. ⋯ Despite published guidelines, most patients with hypertensive crises are poorly managed with potentially severe outcomes.
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Curr Opin Crit Care · Dec 2011
Beyond focused assessment with sonography for trauma: ultrasound creep in the trauma resuscitation area and beyond.
The use of ultrasound for the management of the injured patient has expanded dramatically in the last decade. The focused assessment with sonography for trauma (FAST) has become one of the fundamental skills incorporated into the initial evaluation of the trauma patient. However, there are significant limitations of this diagnostic modality as initially described. Novel ultrasound examinations of the injured patient, although useful, must also be considered carefully. ⋯ The indications for FAST and additional ultrasound studies in the injured patient continue to evolve. Application of sound clinical evidence will avoid unsubstantiated indications for ultrasound to creep into our clinical practice.