Articles: critical-illness.
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To understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing. ⋯ Patients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.
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Introduction: Temperature management is an important aspect of the treatment of critically ill patients, but there are differences in the measurement and management of temperature in different Intensive Care Units (ICUs). The objective of this study was to understand the current situation of temperature measurement and management in ICUs in China, and to provide a basis for standardized temperature management in ICUs. Methods: A 20-question survey was used to gather information on temperature management strategies from ICUs across China. ⋯ The most frequent recommendations for promoting temperature management were continuous monitoring and targeted management. Conclusion: Our investigation revealed a high level of variability in the methods of temperature measurement and management among ICUs in China. Since fever is a common clinical symptom in critically ill patients and can lead to prolonged ICU stays, we propose that standardized guidelines are urgently needed for the management of body temperature (BT) in these patients.
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Journal of critical care · Dec 2023
Population pharmacokinetics of dexamethasone in critically ill COVID-19 patients: Does inflammation play a role?
The aim of this study is to design a population pharmacokinetic study to gain a deeper understanding of the pharmacokinetics of dexamethasone in critically ill COVID-19 patients in order to identify relevant covariates that can be used to personalize dosing regimens. ⋯ Dexamethasone PK parameters in ICU COVID patients were substantially different from those from non-ICU non-COVID patients, and inflammation may play an important role in dexamethasone exposure. This finding suggests that fixed-dose dexamethasone over several days may not be appropriate for ICU COVID patients.
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Curr Opin Crit Care · Dec 2023
ReviewAdults are just big kids: pediatric considerations for adult critical care nephrology.
In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician. ⋯ The number of pediatric AKI survivors continues to increase, leading to a higher burden of chronic kidney disease and other long-term co-morbidities later in life. Adult medical providers should consider pediatric history and illnesses to inform the care they provide. Such knowledge may help internists, nephrologists, and intensivists alike to improve risk stratification, including a lower threshold for monitoring for AKI and kidney dysfunction in their patients.
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Current demographic change leads to higher number of elderly patients admitted to an ICU. Among other organs also the kidneys show age-related changes, which are associated with a decline in various aspects of renal function. The purpose of this review is to provide an overview of structural and functional changes in elderly and also to specifically address the increased risk of acute kidney injury (AKI) in this population. ⋯ Age-related alterations of the kidneys were found at microscopic and macroscopic levels of the cell. These changes lead to a reduced renal reserve and subsequently to an increased vulnerability of aged kidneys when an additional stressor is added. Age is an independent risk factor for developing AKI. Physicians should take into account the altered renal function in elderly patients and take renal protective measures at an early stage.