Critical care clinics
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Critical care clinics · Jul 2007
ReviewSeverity of illness and organ failure assessment in adult intensive care units.
The critical care community has been using severity and organ failure assessment tools for over 2 decades. The major adult severity assessment models are Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score, and Mortality Probability Model. ⋯ These tools have been used extensively in clinical research involving critically ill patients and for benchmarking and the measurement of performance improvement. Their roles as clinical decision support tools at the bedside await future studies because of their unknown or poor performance at the individual patient level.
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We consider the practical aspects of justifying, planning, implementing, and budgeting for an electronic medical record. Examples include the decision about integrating versus replacing old systems, the timing of implementation for each clinical area, preparation for installing computerized order entry, a discussion about how to implement physician progress notes, and a discussion about how electronic nursing systems interact with the EMR. ⋯ Wireless integration and telemedicine also are addressed, as well as backup, redundant systems and budgeting. The reader will gain a full understanding of the scope of the problems involved in implementing an EMR, and will have a step-by-step description of how to approach the task.
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Critical care clinics · Jul 2007
ReviewAbdominal compartment syndrome: clinical aspects and monitoring.
Markedly elevated intra-abdominal pressures will result in predictable hemodynamic consequences related to compromised venous return. When the hemodynamic abnormalities are associated with organ dysfunction of failure, patients suffer from the abdominal compartment syndrome. ⋯ Vigilance, prompt diagnosis, and intervention for abdominal compartment syndrome will reduce the morbidity and mortality in critically ill. Future challenges include altering resuscitation strategies to reduce ascites formation, earlier diagnosis of organ dysfunction, and intra-organ monitoring techniques.
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The evaluation of hormonal status in critically ill patients is challenging and has many pitfalls. This article reviews proper assessment of glycemic status AND adrenal and thyroid function during critical care.
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Mechanical ventilation, although essential in taking care of acute lung injury and widely used during surgical procedures worldwide, remains a highly debated field. Clinical trials in the last decade have shown convincingly that mechanical ventilation can result in additional mortality in patients with acute lung injury. This understanding has resulted in a resurged interest in mechanical ventilation, and especially in techniques and strategies to further improve mechanical ventilation. This article discusses physiological principles to improve the understanding of mechanical ventilation.