Articles: critical-care.
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Am. J. Respir. Crit. Care Med. · Jan 1995
NHLBI Task Force summary. Task Force on Research in Cardiopulmonary Dysfunction in Critical Care Medicine.
Research accomplishments during the past decade have led to a much greater understanding of molecular, cellular, and pathophysiological derangements occurring in the lung and other organ systems during critical illness. Despite this progress, care of critically ill patients with cardiopulmonary dysfunction remains a major health challenge. ⋯ Key observations gained through clinical and epidemiological studies must be tested in the basic science laboratory. Increased and coordinated efforts in epidemiology, clinical, and basic research are essential for future progress.
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With increasing survival rates from acute medical or surgical emergencies a new form of peripheral neuropathy, CIP, has been recognized. CIP can be seen only in patients who are considered to be critically ill; therefore, it invariably occurs in the ICU. Typically, initial symptoms begin with transient (hours to a few days) septic encephalopathy followed by generalized weakness, manifested in weaning failure, limb weakness and hyporeflexia. ⋯ Prognosis is poor in severe cases, in which the EMG also shows severe axonal degeneration. In milder forms, fair to good recovery is expected within weeks. Management includes treatment of sepsis, normalization of failing organ function, physical therapy and proper nutrition.
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Severe neurologic illness and injury in children may occur in a wide range of clinical and environmental settings. The majority of children who sustain traumatic brain injury will achieve a good outcome if intensive care is directed toward preventing secondary injury. ⋯ Together with standard supportive care, the aggressive use of intraventricular pressure monitoring and CSF drainage to treat intracranial hypertension can attenuate or prevent continuing brain injury. Sustained hyperventilation, aggressive diuresis, hypothermia, and induction of barbiturate coma are reserved for children for whom the first tier of therapy is not effective.
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Understanding the various delivery systems of the most commonly used therapies in the critical care setting will help avoid iatrogenic problems and enhance ability to deliver effective goal-oriented critical care. Rational use of oxygen is a result of understanding the goals, complications, and risks of oxygen therapy.