Current opinion in critical care
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To investigate the impact of critical illness polyneuropathy and critical illness myopathy on short-term and long-term patient outcome. ⋯ Intensive care unit-acquired critical illness polyneuropathy and critical illness myopathy influence the evaluation of acutely ill comatose patients and may instigate unreasonably pessimistic prognosis. Critical illness polyneuropathy and critical illness myopathy are an important cause of difficult weaning of patients from the ventilator and of persisting muscle weakness and disability after intensive care unit discharge.
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To bring to the attention of the clinician the metabolic effects of most common sedatives and analgesics used in critically ill patients. ⋯ Metabolically critical illness can be divided in two phases, and acute and a prolonged one. Whereas the acute or hypermetabolic phase is characterized by elevated circulating concentration of catabolic hormones and substrate utilization to provide energy to vital organs, the prolonged or catabolic phase of critical illness is marked by reduced endocrine stimulation and severe loss of body cell mass. The most common analgesic and sedative agents used in the intensive care unit, if used in small or moderate doses, do not interfere significantly with the metabolic milieu; however, prolonged infusions, and in high doses, without adequate monitoring of level of sedation and quality of analgesia, can precipitate morbid events. Further research is needed in the metabolic aspects of analgesia and sedation in the intensive care unit, particularly if a multimodal pharmacologic strategy is used whereby multiple interventions aim at minimizing the risk of overdosing and contributing to attenuation of the stress response associated with critical illness.
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Curr Opin Crit Care · Aug 2005
ReviewGlycemic and nonglycemic effects of insulin: how do they contribute to a better outcome of critical illness?
This review gives an overview of the clinical outcome benefits associated with intensive insulin therapy administered to critically ill patients and of the progress in the unraveling of the mechanisms underlying these positive effects. ⋯ Substantial progress has been made in the understanding of the mechanisms underlying the improved survival and reduced morbidity with intensive insulin therapy in critical illness. More studies, however, are needed to further elucidate the exact pathways involved and the relative contribution of prevention of glucose toxicity and direct nonglycemic effects of insulin.
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Curr Opin Crit Care · Aug 2005
ReviewLung transplantation: donor and recipient critical care aspects.
The purpose of this paper is to highlight new developments in donor and recipient lung transplant issues for the critical care physician. ⋯ Patients undergoing lung transplantation continue to be very challenging in the intensive care unit. A multidisciplinary approach to care, and early recognition of serious problems, will help improve outcomes.