Articles: patients.
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To present an overview of the principles of renal replacement therapy, its application in the critically ill patient, and an update of recent research in this area. ⋯ Continuous renal replacement therapy has become commonplace in the management of critically ill patients with acute renal failure. It has the advantage of causing less hypotension and a more gradual return of the fluid and electrolyte status, when compared with intermittent haemodialysis. Recent evidence suggests that it may also be a useful immunomodulator and may be beneficial in the management of patients with multiple organ failure.
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To review the indications and complications of the percutaneous tracheostomy compared with the standard surgical tracheostomy in the critically ill patient. ⋯ In the critically ill patient who requires a tracheostomy, the percutaneous rather than the standard surgical technique is the method of choice as it can be performed at the bedside, leaves a smaller scar after decannulation and may be associated with fewer complications compared with the standard surgical technique.
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To describe and evaluate clinically applicable approaches to measurement of respiratory mechanics in critically ill patients. ⋯ Some of this information is available on modern ventilators, but greater insight requires measurement and manipulation of flow and pressure data using a pneumotachograph and pressure transducers. Given the importance of respiratory mechanics in the management of many critically ill patients, and given how poorly the respiratory system is monitored compared with the cardiovascular system, it is worth considering making this simple but additional effort.
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Chest trauma in childhood is relatively uncommon in clinical practice, and has been the subject of few reports in the literature. This study was undertaken to examine our experience in dealing with chest trauma in children. ⋯ The prevalence of chest trauma in children due to road traffic accidents is high in Saudi Arabia. Head injury is thought to be the most common associated extrathoracic injuries, however, most of these patients can be managed conservatively.
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Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. ⋯ These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.