Articles: function.
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Minerva anestesiologica · Mar 2015
ReviewManagement of pediatric delirium in critical illness: a practical update.
Pediatric delirium (PD) is an acute state of brain dysfunction and is often seen in the pediatric intensive care unit (PICU). There is a growing awareness of its clinical interdisciplinary importance. The aim of this article was to describe the three clinical presentations, to evaluate the differential diagnosis and to give a concise and practical update for the pharmacological and non-pharmacological treatment of PD at the PICU, based on recent literature and expert opinions. We discuss an interdisciplinary flow chart which helps the reader dealing with the diagnosis and management of any acute emotional and or behavioral disturbance, of which PD is a special case.
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In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
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Comparative Study
Poor symptom control is associated with reduced CT segmental airway lumen area in asthmatic smokers.
Cigarette smoking is associated with worse symptoms in asthma and abnormal segmental airways in healthy subjects. We tested the hypothesis that current symptom control in smokers with asthma is associated with altered segmental airway dimensions measured by CT scan. ⋯ The CT scan segmental airway lumen area is reduced in smokers with asthma compared with never smokers with asthma, particularly in severe disease, and is associated with worse current symptom control and small airway dysfunction.
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Patients with chronic pain usually suffer from cognitive impairment, with memory deterioration being the most common deficit that affects daily functioning and quality of life. The causes for this impairment are not clear despite intensive clinical studies. Few studies have evaluated impaired learning using animal models of persistent pain. ⋯ The results of this study suggest that trigeminal neuralgia induced by cobra venom in adult rats can impair spatial learning and memory function over time and results in demonstrable changes in the ultrastructure of the medulla oblongata. This new animal model may be useful for future studies on the effect of chronic pain on learning and cognition.
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Intensive care medicine · Mar 2015
Observational StudyIncidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients.
Skin mottling is frequent and can be associated with an increased mortality rate in ICU patients with septic shock. Its overall incidence in ICU and its impact on outcome is unknown. We aimed to assess the incidence of skin mottling over the knee among all critically ill patients admitted in ICU and its role on their outcome. ⋯ Skin mottling is frequent in the general population of patients admitted in ICU. Occurrence and persistence of skin mottling are independently associated with in-ICU mortality.