The Surgical clinics of North America
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Surg. Clin. North Am. · Dec 2012
ReviewTwo case studies of cardiopulmonary effects of intra-abdominal hypertension.
Intra-abdominal hypertension falsely elevates the pulmonary artery pressure. Volumetric pulmonary artery catheter monitoring is an optionfor estimating preload in this condition. ⋯ Pulmonary hypertension reduces cardiac function which may be improved with inotropes that simultaneously reduce pulmonary artery pressure. Oxygenation may be improved with elevated PEEP and FiO(2).
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Timing and route of nutrition provided to critically ill patients can affect their outcome. Early enteral nutrition has been shown to decrease specifically infectious morbidity in the critically ill patient. There is a small group of patients who are malnourished on arrival to the intensive care unit and in these patients parenteral nutrition is beneficial.
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Sepsis in the surgical patient continues to be a common and potentially lethal problem. Early identification of patients and timely implementation of evidence-based therapies continue to represent significant clinical challenges for care providers. The implementation of a sepsis screening program in conjunction with protocol for the delivery of evidence-based care and rapid source control can improve patient outcomes. The article provides definitions and guidelines for the screening and management of sepsis and septic shock.
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Pain management in the intensive care unit (ICU) is a complex process. Both the experience of pain as well as its treatment can have consequences relating to the overall outcome of the patient. Further, lack of the ability of many patients in the ICU to communicate their distress makes it even more critical for the ICU practitioner to understand the typical causes of pain in this setting and the applicability of many pain management regimens.