Critical care clinics
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An advanced understanding of acid-base physiology is central to the practice of critical care medicine. Intensivists spend much of their time managing problems that are related to fluids, electrolytes, and blood pH. ⋯ All changes in blood pH, in health and in disease, occur through changes in these three variables. This article reviews the physical-chemical approach to acid-base balance and considers clinical implications for these findings.
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Acute renal failure in critically ill patients is a growing clinical problem. Options for renal replacement therapy in these patients use convective and diffusive clearance and may be intermittent, as in classic hemodialysis, or continuous. ⋯ It may be that renal replacement therapy needs to be tailored to the needs of each individual patient. Current and future research studies should provide the answers to many of these questions.
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Critical care clinics · Jan 2005
ReviewManaging infection in the critical care unit: how can infection control make the ICU safe?
The goal of this article is to use ventilator-associated pneumonia (VAP) as a prototype for nosocomial infections to explore the issues of patient safety and infection control. To do this, we review disease-specific aspects of VAP, develop a brief working definition of patient safety, and then determine how the concepts of infection control fit into the broader context of patient safety.
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Critical care has become an important part of the health care system; however, it still is provided in a heterogeneous, and likely suboptimal, fashion. Future challenges will include providing an adequate workforce; ensuring critical care is delivered to the right patients at the right time; converting advances in our understanding of the biology of critical illness into improved care and outcomes; and partnering successfully with patients, families, and society in forging the critical care of the future.