Circulation and circulatory support in the critically ill

2010 ◽  
pp. 3122-3131
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Cause Of Death ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Cardiovascular Dysfunction ◽  
Vast Array

Cardiovascular dysfunction is common in the critically ill patient and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine....

Circulation and circulatory support in the critically ill

2020 ◽  
pp. 3881-3891
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Assessment ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Vast Array ◽  
Bedside Echocardiography ◽  
Diagnostic Approaches

Cardiovascular dysfunction is common in critically ill patients and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine. Cardiovascular performance can be assessed clinically at the bedside and through haemodynamic monitoring, and with therapeutic or other proactive interventions. Rapid assessment of shocked patients by bedside echocardiography is increasingly used in those institutions where equipment and expertise are available. Diagnostic approaches or therapies based on data derived from invasive haemodynamic monitoring in the critically ill patient assume that specific patterns of derangement reflect specific disease processes, which will respond to appropriate intervention.

scholarly journals Narrative review of ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): clinical applications in intensive care medicine

2020 ◽  
Vol 44 (9) ◽  
pp. 551-565
Author(s):  
V. Fraile Gutiérrez ◽  
J.M. Ayuela Azcárate ◽  
D. Pérez Torres ◽  
L. Zapata ◽  
A.L. Rodríguez Yakushev ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Clinical Applications ◽  
Narrative Review ◽  
Critically Ill Patient

Intensive care medicine on military operations in the resource-limited environment: a case series

2020 ◽  
pp. jramc-2019-001344
Author(s):  
Jeyasankar Jeyanathan ◽  
D O'Brien ◽  
J E Smith
Keyword(s):  
Intensive Care ◽  
United Nations ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Critically Ill Patient ◽  
Military Operations ◽  
Field Hospital ◽  
Resource Limited

This paper describes a series of critically ill patients who were cared for at a UK military field hospital during Op TRENTON 4, in support of the United Nations Mission in South Sudan. These cases highlight the potential challenges in managing the critically ill patient during contingency operations that take place in an austere resource-limited environment.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

Pleural Disease in the Intensive Care Unit

2000 ◽  
Vol 15 (2) ◽  
pp. 63-89
Author(s):  
Michael A. Jantz ◽  
Steven A. Sahn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Critically Ill ◽  
Bronchopleural Fistula ◽  
Tension Pneumothorax ◽  
Respiratory Physiology ◽  
Critically Ill Patient ◽  
Pleural Disease ◽  
The Impact

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.

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