How do I determine Cortisol deficiency in the critically ill patient?

2016 ◽  
Author(s):  
Jeremy Tomlinson
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient ◽  
Cortisol Deficiency

The timing of tracheostomy in critically ill patient

ORL ro ◽  
2017 ◽  
Vol 2 (35) ◽  
pp. 20
Author(s):  
Liliana Mirea ◽  
Raluca Ungureanu ◽  
Daniel Mirea ◽  
Mirela Țigliș ◽  
Ioana Cristina Grințescu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient

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.

scholarly journals Simultaneous spontaneous pneumomediastinum and pneumopericardium in a critically ill patient with COVID-19

2021 ◽  
Author(s):  
Mohammad Javad Behzadnia ◽  
Abbas Samim ◽  
Fatemeh Saboori ◽  
Mosa Asadi ◽  
Mohammad Javanbakht
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient ◽  
Spontaneous Pneumomediastinum

scholarly journals Pneumocystis and SARS-CoV-2 Co-Infection: A Case Report and Review of an Emerging Diagnostic Dilemma

2020 ◽  
Author(s):  
Carlos Rubiano ◽  
Kathleen Tompkins ◽  
Subhashini A Sellers ◽  
Brian Bramson ◽  
Joseph Eron ◽  
...  
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Therapeutic Strategies ◽  
Pneumocystis Jirovecii ◽  
Critically Ill Patient ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Diagnostic Dilemma

Abstract We present a case of a critically ill patient with COVID-19 found to have AIDS and Pneumocystis jirovecii pneumonia (PCP). COVID-19 and PCP co-occurrence is increasingly reported and may complicate diagnostic and therapeutic strategies. Patients with severe COVID-19 should be screened for underlying immunocompromise and coinfections should be considered.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

Volume-Based Feeding in the Critically Ill Patient

2014 ◽  
Vol 39 (6) ◽  
pp. 707-712 ◽  
Author(s):  
Stephen A. McClave ◽  
Mohamed A. Saad ◽  
Mark Esterle ◽  
Mary Anderson ◽  
Alice E. Jotautas ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patient

Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

2016 ◽  
Vol 43 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Massimo Zambon ◽  
Massimiliano Greco ◽  
Speranza Bocchino ◽  
Luca Cabrini ◽  
Paolo Federico Beccaria ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patient ◽  
Diaphragmatic Dysfunction
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