Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Jan 2014
ReviewManagement of pain, agitation, and delirium in critically ill patients.
Pain, agitation, and delirium (PAD) are common in critically ill patients. Consequently, analgesic and sedative medications are frequently administered to critically ill patients to treat PAD, to improve synchrony with mechanical ventilation, and to decrease the physiological stress response. However, prolonged, continuous deep sedation of intensive care unit (ICU) patients is associated with numerous adverse outcomes, including longer durations of mechanical ventilation, prolonged ICU stays, acute brain dysfunction, and an increased risk of death. ⋯ An interdisciplinary team-based approach, using proven process improvement strategies, and ICU patient and family activation and engagement, will help ensure successful implementation of the ICU PAD Care Bundle in ICUs. This paper highlights the major recommendations of the 2013 ICU PAD Guidelines. We hope this review will help ICU physicians and other health care providers advance the management of PAD in critically ill patients, and improve patients' clinical outcomes.
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Pol. Arch. Med. Wewn. · Jan 2014
Multicenter StudyNoninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure.
Noninvasive ventilation (NIV) has changed the prognosis of patients with chronic obstructive pulmonary disease (COPD) suffering from hypercapnic exacerbations. ⋯ Team expertise in NIV and identification of the risk factors for NIV failure may allow to treat patients with more severe hypercapnic exacerbations of COPD during and improve treatment success rates.
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Pol. Arch. Med. Wewn. · Jan 2014
Venous thrombosis: who should be screened for thrombophilia in 2014?
Venous thromboembolism (VTE) is a chronic disease. Recurrence can be prevented by anticoagulants, albeit at the cost of bleeding. Assessing the risk of recurrence is important to balance the risks and benefits of anticoagulation. ⋯ The absence of a laboratory abnormality does not necessarily mean that the recurrence risk is low. A negative result could thus potentially result in a false sense of safety for patients and physicians, and consequently in undertreatment. In summary, routine laboratory thrombophilia screening is no longer warranted.