Critical care : the official journal of the Critical Care Forum
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For many reasons it is crucial that treating intensivists have (regular) contact with general practitioners (GPs). Information about the premorbid condition of the patient, their will and wishes, is of importance to be able to set appropriate treatment goals. ⋯ Additionally, the GP can play an important early role in the support of relatives, provided the GP is timely informed. This kind of communication should be organized in a structured way within the intensive care unit department.
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Recruitment maneuvers have been the subject of intense investigation. Their role in the acute care setting is debated given the lack of information on their influence on clinical outcomes. ⋯ Another possible downside is bacterial translocation secondary to lung overdistention, as suggested by experimental and initial clinical data. When a recruitment maneuver is performed, the patho-physiological consequences of lung recruitment should guide clinicians more than oxygenation improvement alone.
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A survey among pediatric intensive care physicians showed that a great disparity exists between physicians' beliefs regarding hyperglycemia in critically ill patients and their daily practices to screen and treat hyperglycemia. One of the most prominent reasons for hesitating to implement tight glycemic control is the fear of evoking iatrogenic hypoglycemia. Results from ongoing and future studies focusing on both short- and long-term effects of tight glycemic control in broad populations of critically ill children can provide further strong evidence for implementing tight glycemic control. Improving the accuracy of bedside blood glucose measurements and developing reliable computer algorithms to steer insulin infusions can help to overcome the fear of evoking iatrogenic hypoglycemia.
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Clinicians depend on recognizing particular critical illnesses (such as sepsis and cardiac failure) from patterns of vital signs. The relationship between a vital sign pattern and a specific condition is explored.
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There is an increasing interest in biphasic positive airway pressure with spontaneous breathing (BIPAP+SBmean), which is a combination of time-cycled controlled breaths at two levels of continuous positive airway pressure (BIPAP+SBcontrolled) and non-assisted spontaneous breathing (BIPAP+SBspont), in the early phase of acute lung injury (ALI). However, pressure support ventilation (PSV) remains the most commonly used mode of assisted ventilation. To date, the effects of BIPAP+SBmean and PSV on regional lung aeration and ventilation during ALI are only poorly defined. ⋯ In this model of ALI, the reduction of tidal re-aeration and hyperaeration during BIPAP+SBmean compared to PSV is not due to decreased nonaerated areas at end-expiration or different distribution of ventilation, but to lower tidal volumes during BIPAP+SBspont. The ratio between spontaneous to controlled breaths seems to play a pivotal role in reducing tidal re-aeration and hyperaeration during BIPAP+SBmean.