Normal physiology of the renal system

2016 ◽  
Author(s):  
Bruce Andrew Cooper
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Renal Dysfunction ◽  
Critical Role ◽  
Renal Physiology ◽  
Electrolyte Balance ◽  
Care Environment ◽  
System P ◽  
Urine Production ◽  
The Impact

Patients with critical illness often have renal dysfunction, either primary or secondary, that can both complicate and prolong their medical management. Therefore, an understanding of normal renal physiology can help recognize the process or processes that caused the renal dysfunction, and determine the most appropriate corrective and supportive care. The kidney has many important roles other than just urine production. The impact of kidney disease is often predictable. The kidney plays a critical role in fluid and electrolyte balance via many specialized transmembrane pathways. The kidney is also involved in the production and modification of two key hormones and one enzyme. Understanding normal renal physiology can help determine clinical management.This chapter summarizes the important aspects of renal physiology relevant to those who work in a critical care environment.

Drug-Induced Metabolic Disorders and Parenteral Nutrition in the Intensive Care Unit: A Pharmaceutical and Metabolic Perspective

DICP ◽  
1989 ◽  
Vol 23 (5) ◽  
pp. 363-371 ◽  
Author(s):  
Joseph F. Dasta ◽  
David F. Driscoll
Keyword(s):  
Critical Care ◽  
Parenteral Nutrition ◽  
Metabolic Disorders ◽  
Care Setting ◽  
Critical Role ◽  
Critical Care Setting ◽  
Nutrition Support ◽  
Sensitive Period ◽  
Electrolyte Balance ◽  
Drug Induced

Since its inception, the field of parenteral nutrition has continued to evolve requiring the expertise of several health care disciplines. This feature has made nutrition support unique among clinical subspecialties. As a member of this team, the pharmacist plays a critical role in the provision of sterile admixtures, compatible nutritional formulations, and cost-effective, therapeutically equivalent strategies. The pharmacist has become more involved in the clinical care of the patient, with particular emphasis on the development of drug-induced metabolic disorders. The multitude of drugs prescribed to hospitalized patients increases the potential for serious metabolic disturbances. This is especially true in the critical care setting where sudden changes in metabolism (e.g., acid-base homeostasis, fluid and electrolyte balance) may result in profoundly negative effects. The critical care setting also represents the most sensitive period of hospitalization where even subtle changes in metabolic homeostasis may assume major clinical significance. Early recognition of offending agents and the institution of appropriate intervention may avert serious iatrogenic diseases. The nutrition support team is in a unique position to address many such disorders through selective manipulation of the various components in the parenteral nutrient admixture. The ability of the pharmacist to recognize the development of drug-induced metabolic disorders lends further support for clinical pharmacy in nutrition support services.

Valve disease in critical illness

2017 ◽  
Author(s):  
Claire Colebourn ◽  
Jim Newton
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Infective Endocarditis ◽  
Critical Illness ◽  
Care Setting ◽  
Valve Disease ◽  
Mitral Valves ◽  
Valve Lesion ◽  
The Impact ◽  
Valve Lesions

This chapter describes the pathophysiology and methods of assessment of valve lesions affecting the aortic and mitral valves. It describes the management of these valve lesions in the critical care setting and guides decision-making about the impact of the valve lesion on the critical illness. The diagnosis and management of infective endocarditis are described in detail.

Telemedicine in critical care

2016 ◽  
Author(s):  
Bela Patel ◽  
Eric J. Thomas
Keyword(s):  
Critical Care ◽  
Best Practices ◽  
Bloodstream Infections ◽  
Ventilator Associated Pneumonia ◽  
Care Model ◽  
Stress Ulcers ◽  
Care Environment ◽  
The Past ◽  
The Usa ◽  
The Impact

The majority of critically-ill patients are admitted to hospitals that do not have physician intensivist coverage, despite strong evidence that clinical outcomes are improved with intensivist staffing. Telemedicine can leverage clinical resources by providing critical care expertise to patients in intensive care units (ICUs) by off-site clinicians using video, audio, and electronic links. In the past 10 years, telemedicine in critical care has seen tremendous growth in the number of ICU patients being supported by this care model across the USA. The impact of ICU telemedicine coverage has been studied rigorously only in a few studies and the outcomes have been mixed and inconsistent. Telemedicine has been shown in some studies to improve adherence to ICU best practices for the prevention of deep venous thrombosis, stress ulcers, ventilator-associated pneumonia, and catheter-related bloodstream infections. Further research in ICU telemedicine is required to understand the variability of outcomes among the telemedicine programmes studied and to effectively implement the technology to consistently improve outcomes and reduce costs in the critical care environment.

The patient within the critical care environment

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Infection Control ◽  
Critically Ill Patients ◽  
Critical Care Unit ◽  
Holistic Approach ◽  
Care Environment ◽  
The Common ◽  
Prolonged Stress ◽  
Dying Patient

Both critical illness and treatment in the critical care unit are extremely stressful, presenting great physical and psychological challenges for patients and their families. There are a range of compensatory responses to stress which may be adaptive, but severe or prolonged stress can induce a destructive spiral of decompensation. The importance of a holistic approach to care cannot be overemphasized; this chapter sets out the priorities of care for critically ill patients, and the common needs and problems for both patients and their families. The issues discussed include the mechanisms of stress in critical illness, the promotion of sleep, use of analgesia and sedation, management of delirium, complications of immobility, mouth, eye, and skin care, infection control, requirements for safe transfer, and care of the dying patient.

The critical care environment

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Clinical Information ◽  
Electronic Patient Records ◽  
Care Environment ◽  
Team Working ◽  
Use Of Technology ◽  
Design Structure ◽  
Key Factor ◽  
The Impact ◽  
Location Design

This chapter details the optimal location, design, structure, staffing, and equipment required to support high quality critical care. The chapter covers the impact of the critical care environment on patients, family, and staff themselves. The use of technology, including clinical information systems and electronic patient records, is described. Staffing numbers and roles and the importance of team working and collaboration as a key factor in the effectiveness of the critical care environment are also covered. The impact of cleanliness and infection control features as part of the design. The role that the environment has in mitigating the impact on patients in critical care as well as improving outcomes is described as well as other aspects of safety within critical care.

Renal Acid–Base

2019 ◽  
pp. 165-178
Author(s):  
Olakunle Idowu
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Renal Function ◽  
Critical Care ◽  
Critical Role ◽  
Electrolyte Balance ◽  
Normal Blood Pressure ◽  
Acid Base ◽  
Organ Systems ◽  
Diagnostic Modalities

The renal system plays a critical role in maintaining normal blood pressure, acid–base and electrolyte balance, volume status, and clearance of metabolites. Impairments to kidney function directly affect all other organ systems and have significant implications for morbidity in the critical care setting. Understanding renal disease, it treatment and its replacement is imperative to effectively managing patients in the intensive care unit. This chapter focuses on diagnostic modalities for assessing renal function, acid–base disorders, infection, and electrolyte abnormalities. Here, the authors also focuses on differentiating prerenal, intrinsic renal, and postrenal causes of acute kidney failure, strategies for prevention, and the various forms of dialysis.

scholarly journals Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036096 ◽  
Author(s):  
Christine Adrion ◽  
Bjoern Weiss ◽  
Nicolas Paul ◽  
Elke Berger ◽  
Reinhard Busse ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Stepped Wedge ◽  
Link Type ◽  
Cluster Randomised ◽  
Icu Discharge ◽  
Randomised Controlled ◽  
The Impact

IntroductionSurvival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients’ long-term outcomes if adhered to.Methods and analysisThe protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient’s ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated.Ethics and disseminationThis protocol was approved by the ethics committee of the Charité—Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net).Trial registration numberClinicalTrials.gov Registry (NCT03671447).

Contributions to Critical Care from Psychological Science and Practice

2021 ◽  
pp. 58-100
Author(s):  
Nancy Merbitz ◽  
Joan Fleishman ◽  
Hannah Kamsky ◽  
Stephanie Sundborg ◽  
Jamie Lynne Tingey ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Health Effects ◽  
Healthcare System ◽  
Patient Centered ◽  
Rehabilitation Psychology ◽  
Behavioral Psychology ◽  
History Of ◽  
Social Organizational ◽  
The Impact

In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized.

Critical Care Nursing

2017 ◽  
Keyword(s):  
Critical Care ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Major Incident ◽  
Organ Support ◽  
Evidence Based ◽  
Care Environment ◽  
Organ Systems ◽  
General Aspects ◽  
The Impact

This textbook encompasses the knowledge, skills, and expertise needed to deliver excellent nursing care to critically ill patients. Emphasis is placed on a holistic and compassionate approach towards humanizing the impact of the environment, organ support, and monitoring, as well as critical illness itself. Chapters cover the general aspects of critical care such as the critical care environment or critical care continuum and specific organ systems and diseases. The structure of the systems chapters reminds the reader of the underlying anatomy and physiology as well as highlighting areas of particular relevance to critical care. The focus on priorities for management builds on the ABCDE assessment and offers insight into key interventions in urgent situations as well as outlining evidence-based practice. The book is ideal for those new to the critical care environment, but will also act as a reminder for more experienced nurses when faced with a new situation or when teaching/mentoring students. The patient and their family remain the centre of all This new edition brings the definitions, pathophysiology, and management of fast-changing and challenging areas such as ARDS, sepsis and multiple organ dysfunction, resuscitation, and acute kidney injury up to date as well as including any evidence-based changes associated with nursing practice in critical care. A new chapter covers major incident planning and management and the role of critical care in pandemic situations.

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