Heart & lung : the journal of critical care
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Hypoalbuminemia is a common finding in critically ill patients. It has been well documented that hypoalbuminemic patients have a higher morbidity and mortality rate when compared with patients with a normal serum albumin. ⋯ There is, however, very little evidence that this practice is of any benefit. In this article the physiology of albumin in health and disease is reviewed, and those clinical studies that have investigated the use of albumin in acutely ill hypoalbuminemic patients are evaluated.
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Review Case Reports
Recurrent unilateral lung hyperinflation as a manifestation of "auto-PEEP".
Recurrent right lung hyperinflation developed in a 68-year-old man with chronic airflow obstruction. His past history was significant for tuberculosis in the left lung requiring a left upper lobe resection and residual bronchiectasis in the remaining lung. Recognition of the unilateral lung hyperinflation as being a manifestation of unintentional positive end-expiratory pressure (auto-PEEP) resulted in appropriate measures to reverse the process and prevent further complications such as barotrauma. Patients with chronic airflow obstruction and an inflammatory or fibrotic disease process primarily involving one lung are at risk for the development of this atypical presentation of auto-PEEP.
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To summarize and evaluate evidence on the psychometric properties of the Glasgow Coma Scale (GCS). ⋯ In spite of its acknowledged shortcomings and the emergence of parallel instruments with greater reliability and validity, the GCS continues to enjoy a privileged, but unwarranted, position in clinical and investigational contexts.
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There are six herpes viruses, three of which, the varicella-zoster virus and the herpes simplex viruses types 1 and 2, are of particular concern to patients and staff in critical care units. These viruses, especially in their reactivated states, may present atypically in critically ill and immune-suppressed patients, and, by the time the diagnosis is made, exposures of other patients and clinicians may have occurred. Pregnancy and immunosuppressed states can result in severe, even life-threatening varicella-zoster virus infections in susceptible adults. ⋯ An additional problem after herpes simplex virus infection is the potential of lifelong and possibly frequent recurrences. In this article, the manifestations, modes of transmission, and treatment will be discussed. Special emphasis will be placed on describing the types of patients who are at high risk of presenting with varicella-zoster virus or herpes simplex virus infection so that physicians and nurses can use appropriate preventive measures to avert nosocomial infections in patients and staff.
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Delirium is a common, disruptive, costly, and at times lethal condition found among patients in the acute care setting. Nurses can be the first to discover its presence and thereby reduce the time to treatment. Identifying delirium requires a knowledge of its clinical features, a mastery of the bedside cognitive mental status examination, critical judgment in distinguishing delirium from other psychiatric disorders, and appropriate nursing interventions based on ongoing assessment. In this article we review elements of such an approach and illustrate common clinical challenges for nurses with case examples.