Current opinion in critical care
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Curr Opin Crit Care · Aug 2005
ReviewOrganizational characteristics and the quality of surgical care.
Public recognition of wide variations in surgical outcomes has prompted numerous efforts aimed at measuring and improving quality. Given that many of the most prominent efforts focus on organizational factors, this paper reviews the growing body of evidence underlying these initiatives. ⋯ Several organizational characteristics are strongly related outcomes for critically ill surgical patients. Increasing the number of surgical patients receiving care in hospitals adhering to these organizational practices would save many lives each year.
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Curr Opin Crit Care · Aug 2005
ReviewPotential mechanisms and markers of critical illness-associated cognitive dysfunction.
To review the current understanding of the potential mechanisms of critical illness-associated cognitive dysfunction and to provide insight into markers that could be used to evaluate the influence of specific mechanisms in individual patients. ⋯ Although recent advances in this area are exciting, they are still too immature to influence patient care. Additional research is needed to provide a better understanding of the relative contribution of specific mechanisms to the development of critical illness-associated cognitive dysfunction and to determine whether these mechanisms might be amenable to treatment or prevention.
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Until relatively recently critical care practitioners have focused on survival of their patients and not long-term outcomes. An increasing body of research has examined patient outcomes beyond discharge from the intensive care unit and hospital. One area of focus is neurobehavioral outcomes including neurocognitive sequelae and neuropsychiatric disorders such as depression and anxiety. Cognitive functions are brain-based or mental activities that involve acquiring, storing, retrieving, and using information and include domains such as memory, attention, executive function, mental processing speed, spatial abilities, and general intelligence. It is known from other medical specialties that impaired cognitive function can have a broad, substantial, and long-lasting impact on a patient's life. This paper examines the current evidence for neurocognitive impairments in survivors of critical illness. ⋯ Among the potential consequences of critical illness are now included neurocognitive impairments. Future research should include the search for strategies for the early identification of neurocognitive impairments, mechanisms of brain injury, and therapeutic modalities designed to prevent or decrease neurocognitive morbidity.
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Curr Opin Crit Care · Aug 2005
ReviewEpidemiology and treatment of psychiatric conditions that develop after critical illness.
As a greater number of patients survive critical illness, there is increasing interest in accelerating patients' recovery after intensive care unit discharge. There is compelling evidence that psychiatric illnesses such as depression impair functional status in patients with chronic medical illnesses. Therefore, psychiatric conditions that develop after critical illness are a logical target for treatment or prevention strategies to improve recovery after critical illness. ⋯ Psychiatric symptoms and disorders affect 15%-35% of patients months after intensive care unit discharge. There is no consistent evidence that antidepressant medications are safe or effective in critically ill patients. Understanding the causal pathways that lead from acute medical stress to neuronal alterations and subsequent psychiatric symptoms will allow more precise targeting of preventive interventions.