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Critical Care Clinics

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https://www.readbyqxmd.com/read/30223999/preface-complications-during-and-after-critical-illness
#1
EDITORIAL
Carol L Hodgson
No abstract text is available yet for this article.
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223998/family-and-support-networks-following-critical-illness
#2
REVIEW
Kimberley J Haines, Tara Quasim, Joanne McPeake
Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223997/psychiatric-morbidity-after-critical-illness
#3
REVIEW
Elizabeth Prince, Ted Avi Gerstenblith, Dimitry Davydow, Oscar Joseph Bienvenu
Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. ICU diaries may be effective in decreasing psychiatric morbidity after critical illness, though these and other interventions deserve further study...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223996/sedation-delirium-and-cognitive-function-after-critical-illness
#4
REVIEW
Timothy D Girard
Delirium has been consistently identified as a risk factor for critical illness brain injury, but ICU patients are exposed to a multitude of risk factors for delirium and it remains unclear which of these risk factors should be targeted to improve long-term cognitive outcomes. Because exposure to sedating medications-which are frequently used to treat unwanted yet common symptoms during critical illness-is a risk factor for delirium that is directly controlled by clinicians, the relationship between sedation, delirium, and long-term cognition is of great interest to clinicians, researchers, and patients...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223995/intensive-care-nutrition-and-post-intensive-care-recovery
#5
REVIEW
Jan Gunst, Greet Van den Berghe
Intensive care unit (ICU)-acquired weakness frequently complicates critical illness, which prolongs intensive care dependency and causes long-term burden. Observational studies have suggested that prolonged underfeeding could aggravate ICU-acquired weakness and impair outcome. However, recent large randomized controlled trials have failed to show a benefit of early enhanced nutrition to critically ill patients. Moreover, early parenteral nutrition was even shown to increase ICU-acquired weakness and prolong organ failure and intensive care dependency, which may be explained by feeding-induced suppression of autophagy...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223994/early-mobilization-in-the-intensive-care-unit-to-improve-long-term-recovery
#6
REVIEW
Michelle Paton, Rebecca Lane, Carol L Hodgson
This article outlines the effect of early mobilization on the long-term recovery of patients following critical illness. It investigates the safety of performing exercise in this environment, the differing types of rehabilitation that can be provided, and the gaps remaining in evidence around this area. It also attempts to assist clinicians in prescription of exercise in this cohort while informing all readers about the impact that mobilization can have for the outcomes of intensive care patients.
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223993/the-pathophysiology-of-neuromuscular-dysfunction-in-critical-illness
#7
REVIEW
Matteo Parotto, Jane Batt, Margaret Herridge
Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. As the population ages and accrues a greater burden of comorbid illness and medical complexity, those patients admitted to an intensive care unit will be challenged in their recovery because of diminished organ reserve and variable tissue resiliency. This represents a significant burgeoning public health concern. This article presents a brief overview of the pathophysiology and the emerging basic science of neuromuscular dysfunction in critical illness...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223992/frailty-and-the-association-between-long-term-recovery-after-intensive-care-unit-admission
#8
REVIEW
Carmel L Montgomery, Darryl B Rolfson, Sean M Bagshaw
Frailty is common, although infrequently screened for among patients admitted to intensive care. Frailty has been the focus of research in geriatric medicine; however, its epidemiology and interaction with critical illness have only recently been studied. Instruments to screen for and measure frailty require refinement in intensive care settings. Frail critically ill patients are at higher risk of poor outcomes. Frail survivors of critical illness are high users of health resources. Further research is needed to understand how frailty assessment can inform decision-making before and during an episode of critical illness and during an intensive care course for frail patients...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223991/measuring-outcomes-after-critical-illness
#9
REVIEW
Nathan E Brummel
Outcomes after critical illness remain poorly understood. Conceptual models developed by other disciplines can serve as a framework by which to increase knowledge about outcomes after critical illness. This article reviews 3 models to understand the distinct but interrelated content of outcome domains, to review the components of functional status, and to describe how injuries and illnesses relate to disabilities and impairments afterward.
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223990/preventing-chronic-critical-illness-and-rehospitalization-a-focus-on-sepsis
#10
REVIEW
Hallie C Prescott
An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital admission with in 90 days, most commonly for infection. Treatment should focus on preventing the common sequelae of critical illness during the initial hospitalization, tailoring medical care to minimize the risk for common and potentially preventable causes of hospital readmission, and promoting functional recovery...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/30223989/patient-and-population-level-approaches-to-persistent-critical-illness-and-prolonged-intensive-care-unit-stays
#11
REVIEW
Theodore J Iwashyna, Elizabeth M Viglianti
The differential diagnosis of prolonged intensive care unit (ICU) stays includes intrinsic patient and admitting diagnostic characteristics, occurrences during the course of critical illness, and system failures. Existing data suggest that the most common cause of prolonged ICU stay is the development of new cascading problems, which is now more related to ongoing critical illness than the original reason for ICU admission. Accepting the dynamism inherent in such a clinical course has implications for contemporary clinical care...
October 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907278/challenges-and-future-directions-in-left-ventricular-assist-device-therapy
#12
REVIEW
Manreet K Kanwar, Stephen Bailey, Srinivas Murali
The clinical use of left ventricular assist devices (LVADs) in the growing epidemic of heart failure has improved quality of life and long-term survival for this otherwise devastating disease. The current generation of commercially available devices offers a smaller profile that simplifies surgical implantation, a design that optimizes blood flow characteristics, with less adverse events and improved durability than their predecessors. Despite this, the risk for adverse events remains significant, as do burdens for patients and their caregivers...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907277/complications-of-durable-left-ventricular-assist-device-therapy
#13
REVIEW
Sitaramesh Emani
Heart failure patients on durable left ventricular assist device support experience improved survival, quality of life, and exercise capacity. The complication rate, however, remains unacceptably high, although it has declined with improvements in pump design, better patient selection, and greater understanding of the pump physiology and flow dynamics. Most complications are categorized as those related to the pump-patient interface or those related to patient physiology. It is hoped that further engineering progress, and better patient selection through risk stratification, will allow for left ventricular assist device to be totally biocompatible and perform effectively, without affecting biology and homeostasis of the different organ systems...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907276/device-management-and-flow-optimization-on-left-ventricular-assist-device-support
#14
REVIEW
Inna Tchoukina, Melissa C Smallfield, Keyur B Shah
The authors discuss principles of continuous flow left ventricular assist device (LVAD) operation, basic differences between the axial and centrifugal flow designs and hemodynamic performance, normal LVAD physiology, and device interaction with the heart. Systematic interpretation of LVAD parameters and recognition of abnormal patterns of flow and pulsatility on the device interrogation are necessary for clinical assessment of the patient. Optimization of pump flow using LVAD parameters and echocardiographic and hemodynamics guidance are reviewed...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907275/prevention-and-treatment-of-right-ventricular-failure-during-left-ventricular-assist-device-therapy
#15
REVIEW
Amresh Raina, Maria Patarroyo-Aponte
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. RV failure can be predicted using preoperative hemodynamic, clinical, and echocardiographic variables and a variety of risk prediction algorithms. However, RV failure may also develop due to unanticipated intraoperative or perioperative factors...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907274/a-targeted-management-approach-to-cardiogenic-shock
#16
REVIEW
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907273/extracorporeal-gas-exchange
#17
REVIEW
Onnen Moerer, Francesco Vasques, Eleonora Duscio, Francesco Cipulli, Federica Romitti, Luciano Gattinoni, Michael Quintel
Extracorporeal gas exchange is increasingly used for various indications. Among these are refractory acute respiratory failure, including the acute respiratory distress syndrome (ARDS), and the avoidance of ventilator-induced lung injury (VILI) by enabling lung-protective ventilation. Additionally, extracorporeal gas exchange allows the treatment of hypercapnic respiratory failure while helping to unload the respiratory muscles and avoid intubation and invasive ventilation, as well as facilitating weaning from the ventilator...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907272/noninvasive-options
#18
REVIEW
Giuseppe Bello, Alessandra Ionescu Maddalena, Valentina Giammatteo, Massimo Antonelli
Noninvasive ventilation (NIV) has assumed a central role in the treatment of selected patients with acute respiratory failure due to exacerbated chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema. Recent advances in the understanding of physiologic aspects of NIV application through different interfaces and ventilator settings have led to improved patient-machine interaction, enhancing favorable NIV outcome. In recent years, the growing role of NIV in the acute care setting has led to the development of technical innovations to overcome the problems related to gas leakage and dead space, improving the quality of the devices and optimizing ventilation modes...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907271/automation-of-mechanical-ventilation
#19
REVIEW
Richard D Branson
Closed loop control of mechanical ventilation is routine and operates behind the ventilator interface. Reducing caregiver interactions is neither an advantage for the patient or the staff. Automated systems causing lack of situational awareness of the intensive care unit are a concern. Along with autonomous systems must come monitoring and displays that display patients' current condition and response to therapy. Alert notifications for sudden escalation of therapy are required to ensure patient safety. Automated ventilation is useful in remote settings in the absence of experts...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907270/avoiding-respiratory-and-peripheral-muscle-injury-during-mechanical-ventilation-diaphragm-protective-ventilation-and-early-mobilization
#20
REVIEW
Annia Schreiber, Michele Bertoni, Ewan C Goligher
Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading...
July 2018: Critical Care Clinics
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