Articles: critical-illness.
-
Critical care medicine · Jan 2025
ReviewInduction Agents for Tracheal Intubation in Critically Ill Patients.
Concise definitive review of the use of induction agents in critically ill patients undergoing tracheal intubation and their association with outcomes. ⋯ Although no definitive conclusions can be drawn based on the available evidence, recent evidence pointed out the potential negative effect of etomidate on survival and the association of propofol with cardiovascular instability. Ketamine may be considered the drug with a safer profile, widespread availability and low cost but future research should provide definitive data on optimal drug selection, its dosage in the context of critical illness and concomitant interventions to minimize the risk of peri-intubation complications.
-
Patients and their caregivers navigate multiple transitions of care across the health system as they recover from their critical illness. Current research supports the development of integrated models of care to improve patient outcomes after critical illness. Future research to ensure the development of integrated models across different regions and to understand the optimal mode of delivery of these is required.
-
Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk factors for psychological problems following critical illness have been identified including early symptoms of acute stress. Assessment of psychological symptoms in ICU patients and survivors remains inconsistent and many do not receive appropriate psychological evaluation, diagnosis, or treatment. Screening patients for psychological impairments early and serially following hospitalization is crucial to addressing patients' needs and mitigating long-term distress, as is connecting patients to outpatient mental health follow-up for treatment.
-
Critical care clinics · Jan 2025
ReviewLong-Term Cognitive Function Among Critical Illness Survivors.
Cognitive impairment is common after critical illness and persists beyond the period of acute illness. Clinicians caring for this patient population are encouraged to screen for cognitive impairment and provide supportive measures to mitigate its distressing effects. Further research is needed to evaluate the laboratory and neuroimaging correlates of post-intensive care unit (ICU) cognitive impairment, which may in turn lead to personalized interventions to address this debilitating complication of critical illness. Further research is needed to evaluate the laboratory and neuroimaging correlates of post-ICU cognitive impairment, which may, in turn, lead to personalized interventions to address this debilitating complication of critical illness.
-
Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. ⋯ Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes.