Clinics in chest medicine
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Clinics in chest medicine · Sep 2015
ReviewIntegration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers.
Clinicians working in the intensive care unit (ICU) confront death and dying daily. ICU care can be inconsistent with a patient's values, preferences, and previously expressed goals of care. ⋯ This article discusses the benefits and barriers to integration of ICU and palliative care services, and a stepwise approach to implementation of palliative care services. Integration of palliative care services into ICU workflow is increasingly seen as essential to providing high-quality, comprehensive critical care.
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Recent research has identified promising targets for therapeutic interventions aimed at modulating the inflammatory response in sepsis. Herein, the authors describe mechanisms involved in the clearance of pathogen toxin from the circulation and potential interventions aimed at enhancing clearance mechanisms. The authors also describe advances in the understanding of the innate immune response as potential therapeutic targets. Finally, novel potential treatment strategies aimed at decreasing vascular leak are discussed.
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Clinics in chest medicine · Sep 2015
ReviewManagement of Infections with Drug-Resistant Organisms in Critical Care: An Ongoing Battle.
Infections with multidrug-resistant organisms (MDROs) are common in critically ill patients and are challenging to manage appropriately. Strategies that can be used in the treatment of MDRO infections in the intensive care unit (ICU) include combination therapy, adjunctive aerosolized therapy, and optimization of pharmacokinetics with higher doses or extended-infusion therapy as appropriate. Rapid diagnostic tests could assist in improving timely appropriate antimicrobial therapy for MDRO infections in the ICU.
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Clinics in chest medicine · Sep 2015
ReviewSleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit.
Critical illness is associated with profound sleep disruption. Causality is diverse and includes physiologic, psychological, and environmental factors. There are limited pharmacologic interventions available to treat sleep disturbances in critical illness; however, multidisciplinary strategies that alter the intensive care unit (ICU) environment and cluster care delivery have shown promise in sleep and circadian promotion and delirium reduction. With the appropriate administrative support and involvement of diverse ICU stakeholders, effective strategies could be created, implemented, and maintained to improve sleep disruption in critically ill patients.
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During the last 15 years, critical care services provided via telemedicine have expanded to now be incorporated into the care of 13% of patients in intensive care units (ICUs) in the United States. A response to shortfalls in the availability of critical care-trained providers has evolved into integrated programs of ICU care with contributions to improved outcomes through proactive management, population oversight, and standardization of care processes. The most impactful characteristics of successful ICU telemedicine programs are now better understood with more than a decade of national experience and the accrued benefits to health care systems.