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Critical Care Clinics

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https://www.readbyqxmd.com/read/28601144/psychiatric-aspects-of-critical-care-medicine-update
#1
EDITORIAL
José R Maldonado
No abstract text is available yet for this article.
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601143/psychiatric-and-palliative-care-in-the-intensive-care-unit
#2
REVIEW
Stephanie M Harman
Palliative care is specialized medical care focused on patients with serious illness and their families. In the intensive care unit (ICU), palliative care encompasses core skills to support patients and their families throughout their ICU course and post-ICU stays. Psychiatric symptoms are common among patients approaching the end of life and require particular attention in the setting of sedating medications, typically used when patients require ventilators and other life-sustaining treatments. For patients with preexisting severe mental illness who have a concurrent serious medical illness, a palliative psychiatric approach can address complex symptom management and support ethical and value-based shared decision making...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601142/medical-complications-of-psychiatric-treatment-an-update
#3
REVIEW
Sheila C Lahijani, Kirk A Harris
Psychiatric medications are used commonly in hospitalized patients and are particularly indicated in patients who are critically ill to manage many conditions. Due to their many indications in the intensive care unit (ICU), psychiatric medications should be closely monitored in these medically compromised patients for adverse reactions and medical complications because they may affect essentially all organ systems. These range from life-threatening reactions to other less significant effects, such as sedation, to other detrimental complications, such as pancreatitis...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601141/neuropsychiatric-aspects-of-infectious-diseases-an-update
#4
REVIEW
Sahil Munjal, Stephen J Ferrando, Zachary Freyberg
Among the critically ill, infectious diseases can play a significant role in the etiology of neuropsychiatric disturbances. All critical care physicians are familiar with delirium as a secondary complication of systemic infection. This article focuses on key infectious diseases that commonly and directly produce neuropsychiatric symptoms, including direct infection of the central nervous system, human immunodeficiency virus infection, and AIDS.
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601140/psychiatric-aspects-of-organ-transplantation-in-critical-care-an-update
#5
REVIEW
Yelizaveta Sher, Paula Zimbrean
Transplant patients face challenging medical journeys, with many detours to the intensive care unit. Before and after transplantation, they have significant psychological and cognitive comorbidities, which decrease their quality of life and potentially compromise their medical outcomes. Critical care staff are essential in these journeys. Being cognizant of relevant psychosocial and mental health aspects of transplant patients' experiences can help critical care personnel take comprehensive care of these patients...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601139/posttraumatic-stress-disorder-phenomena-after-critical-illness
#6
REVIEW
Oscar Joseph Bienvenu, Ted-Avi Gerstenblith
This article focuses on a psychiatric morbidity in critical illness survivors, posttraumatic stress disorder (PTSD). We present a case in the second person, because it is helpful to imagine what being critically ill can be like from the perspective of a patient without medical training. One-fifth of critical illness survivors have clinically relevant PTSD symptoms in the year after intensive care, and markers of risk include prior psychiatric illness, benzodiazepine administration in the intensive care unit (ICU), and early post-ICU memories of frightening, nightmare-like experiences during intensive care...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601138/psychiatric-disorders-and-suicidality-in-the-intensive-care-unit
#7
REVIEW
Renee M Garcia
Suicidality is a general term that describes the continuum of suicidal ideation, intent, self-injurious behavior, attempts, and completed suicide. Suicidality across the entire spectrum is a public health concern with significant impact, including billions in work loss and medical costs. There are many challenges to managing suicidality in an intensive care unit setting, which will be reviewed here. Additionally, this article will review the prevalence of suicide attempts in different psychiatric diagnoses, conducting a suicide assessment, role of involuntary psychiatric holds, and most common challenges encountered in the ICU setting...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601137/psychiatric-aspects-of-heart-disease-and-cardiac-aspects-of-psychiatric-disease-in-critical-care
#8
REVIEW
Peter A Shapiro
Strong emotional reactions are common in patients admitted to cardiac critical care; only some are pathological. Cardiac critical care and associated technologies are associated with predictable psychiatric problems. Many occur as secondary complications of the medical status of the patient, which must be carefully assessed. Depression is common in patients with coronary disease and also for patients with heart failure; treatment is helpful, but persistent depression is associated with elevated morbidity and mortality...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601136/psychiatric-aspects-of-lung-disease-in-critical-care
#9
REVIEW
Yelizaveta Sher
Respiratory conditions are some of the most common indications for admission to critical care units. Psychiatric disorders and symptoms are highly comorbid with lung disease. They can occur as a risk factor to lung disease, as a co-occurring condition, as a consequence of a pulmonary condition, or as a treatment side effect either from medications or assistive devices. Patients can experience a myriad of mood, anxiety, and cognitive disorder symptoms and conditions in critical care units. Intensivists and psychiatrists must be aware of the interplay between pulmonary and psychiatric symptoms as well as medication effects and interactions...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601135/novel-algorithms-for-the-prophylaxis-and-management-of-alcohol-withdrawal-syndromes-beyond-benzodiazepines
#10
REVIEW
José R Maldonado
Benzodiazepine (BZDP) agents are the standard for the prophylaxis and treatment of all phases of alcohol withdrawal syndrome. However, BZDPs have their drawbacks: cognitive impairment, significant neurologic and medical side effects. There are data suggesting that the alcohol recidivism rate and abuse potential is higher for BZDPs treated patients, compared to alternatives. Clinical and research data demonstrate the efficacy and safety of various pharmacologic alternatives to benzodiazepines for the prevention and management of AWS...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601134/substance-use-intoxication-and-withdrawal-in-the-critical-care-setting
#11
REVIEW
Joseph H Donroe, Jeanette M Tetrault
Substance use is common among individuals admitted to the critical care setting and may complicate treatment of underlying disorders. Management issues include the effects of intoxication as well as the risk posed by substance-withdrawal syndromes in patients being treated for critical illness. This article reviews the epidemiology of substance use in this population and the identification and treatment of common intoxication and withdrawal syndromes. The authors stress the importance of long-term planning as part of the overall treatment protocol beyond the acute presentation...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601133/assessment-and-management-of-toxidromes-in-the-critical-care-unit
#12
REVIEW
J J Rasimas, Courtney M Sinclair
The most important diagnostic factor in uncovering a toxic etiology for delirium or critical illness is the clinician's openness to the possibility of its existence. Therefore, a consulting psychiatrist, already prepared to perform the detail-oriented work of sorting out behavioral manifestations of disease, can be a vital asset at the bedside if also attuned to the role of purposeful, accidental, and iatrogenic exposures in the intensive care unit. This article summarizes the presentation, evaluation, and treatment of toxidromes relevant to the work of acute psychosomatic medicine...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601132/acute-brain-failure-pathophysiology-diagnosis-management-and-sequelae-of-delirium
#13
REVIEW
José R Maldonado
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601131/detection-and-management-of-preexisting-cognitive-impairment-in-the-critical-care-unit
#14
REVIEW
Mark A Oldham, Walter Piddoubny, Ryan Peterson, Hochang B Lee
Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28601130/neurobehavioral-management-of-traumatic-brain-injury-in-the-critical-care-setting-an-update
#15
REVIEW
Earl De Guzman, Andrea Ament
Traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI is a major cause of disability and mortality worldwide. Post-traumatic amnesia, or the interval from injury until the patient is oriented and able to form and later recall new memories, is an important index of TBI severity and functional outcome. This article will discuss the updates in the epidemiology, definition and classification, pathophysiology, diagnosis, and management of common acute neuropsychiatric sequelae of traumatic brain injury that the critical care specialist may encounter...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284303/advances-in-surgical-critical-care-2017-growing-population-and-personalized-protocols
#16
EDITORIAL
Lena M Napolitano
No abstract text is available yet for this article.
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284302/critical-care-nutrition-where-s-the-evidence
#17
REVIEW
Jayshil J Patel, Ryan T Hurt, Stephen A McClave, Robert G Martindale
The surgical critically ill patient is subject to a variable and complex metabolic response, which has detrimental effects on immunity, wound healing, and preservation of lean body muscle. The concept of nutrition support has evolved into nutrition therapy, whereby the primary objectives are to prevent oxidative cell injury, modulate the immune response, and attenuate the metabolic response. This review outlines the metabolic response to critical illness, describes nutritional risk; reviews the evidence for the role, dose, and timing of enteral and parenteral nutrition, and reviews the evidence for immunonutrition in the surgical intensive care unit...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284301/perioperative-acute-kidney-injury-risk-factors-and-predictive-strategies
#18
REVIEW
Charles Hobson, Rupam Ruchi, Azra Bihorac
Acute kidney injury (AKI) is a common complication in surgical patients and is associated with increases in mortality, an increased risk for chronic kidney disease and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs, and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques, and novel biomarkers for early detection of AKI provides new tools toward these ends...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284300/renal-replacement-therapy-in-acute-kidney-injury-controversies-and-consensus
#19
REVIEW
Michael Heung, Lenar Yessayan
Acute kidney injury (AKI) is a common complication among critically ill patents, and 5% of intensive care unit (ICU) patients require initiation of renal replacement therapy (RRT). In recent years, clinical trials have provided evidence-based guidance for some important aspects of RRT management in patients with AKI, such as dialysis dosing and approaches to anticoagulation in patients undergoing continuous RRT. However, there remain many areas of uncertainty, and delivery of RRT in the ICU requires clinical judgment, flexibility, and an understanding of dialysis principles...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28284299/anemia-and-red-blood-cell-transfusion-advances-in-critical-care
#20
REVIEW
Lena M Napolitano
Anemia is common in the intensive care unit (ICU), resulting in frequent administration of red blood cell (RBC) transfusions. Significant advances have been made in understanding the pathophysiology of anemia in the ICU, which is anemia of inflammation. This anemia is related to high hepcidin concentrations resulting in iron-restricted erythropoiesis, and decreased erythropoietin concentrations. A new hormone (erythroferrone) has been identified, which mediates hepcidin suppression to allow increased iron absorption and mobilization from iron stores...
April 2017: Critical Care Clinics
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