Critical care : the official journal of the Critical Care Forum
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Methadone, the most widely delivered maintenance therapy for heroin addicts, may be responsible for life-threatening poisonings with respiratory depression. The toxicokinetics and the toxicokinetic/toxicodynamic (TK/TD) relationships of methadone enantiomers have been poorly investigated in acute poisonings. The aim of this study was to describe the relationships between methadone-related respiratory effects and their corresponding concentrations. ⋯ After the ingestion of a toxic dose of a racemic mixture, plasma R- and S-enantiomer concentrations decreased in parallel. Despite large inter-individual variability in methadone toxicokinetics and toxicodynamics, TK/TD relationships would be helpful for providing quantitative data regarding the respiratory response to methadone in poisonings. However, further confirmatory TK/TD data are needed.
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The aim of this study was to assess the incidence of organ failure in trauma patients treated in an intensive care unit (ICU), and to study the relationship between organ failure and long-term survival and functional status. ⋯ Almost half of the ICU trauma patients had MOF. While single organ failure had no impact on long-term outcomes, the presence of MOF greatly increased mortality and the risk of impaired functional status. MOF expressed by SOFA score may be used to define trauma patients at particular risk for poor long-term outcomes.
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Patients in critical care lose their capability to make a judgement, and constitute a 'vulnerable population' needing special and reinforced protection. Even if the standard of informed consent is an essential way of demonstrating respect for the patient's autonomy, the usual informed-consent procedure is not as applicable as required or sufficient to warrant this ethical principle in critical care.
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Comment
Medical post-traumatic stress disorder: catching up with the cutting edge in stress research.
We briefly summarize two original research papers and a review article. We then review the formal structure of the diagnosis of post-traumatic stress disorder (PTSD) and discuss the use of continuous measures of PTSD in comparison with diagnostic instruments. ⋯ By examining current studies, we demonstrate that medical PTSD is lagging in fundamental and interventional research but we discuss how medical PTSD has unique opportunities to develop causal models that could inform the greater field of stress studies. We conclude by advocating that future medical PTSD research efforts should focus on understanding how fundamental brain processes are affected during acute medical stress.
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Why is the practice of intensive care so heterogenous? Uncertainty as to 'best practice', conservatism, and complacency may all contribute to our divergent management strategies. The need for further generalisable research, anonymised audit, external peer review and open access databases is discussed.