Critical care clinics
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Cardiac surgical emergencies are broken down into three categories: cardiac trauma, aortic dissection, and surgery for acute myocardial infarctions. Emphasis is given to describing the presentation of patients with such problems, and to the salient aspects of the clinical strategies for managing each problem. An important goal of each section is focusing the critical care physician on the early recognition of cardiac surgical emergencies and providing him with some rationale for instituting an expeditious plan of therapy.
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Critical care clinics · Apr 1989
ReviewRational approach to the management of multiple systems organ failure.
MSOF is a complicated disorder that can involve every organ system in the body. Whatever causes or perpetuates the syndrome, its management involves the prevention and treatment of infection, the maintenance of tissue oxygenation, nutritional and metabolic support, and the support of individual organ systems. ⋯ It also is potentially harmful in that measures used to benefit some organ systems may be detrimental to others. Further research is needed both to understand MSOF and to improve its management.
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Over the past 20 years, substantial information has been gained concerning sepsis-associated ALI. Although the mortality from ARDS remains unchanged, the spectrum of disease has altered. Patients rarely die acutely from the direct sequelae of ALI, including hypoxemia, but most commonly demonstrate a protracted clinical course that eventuates in MSOF. ⋯ Without an effective and singular "golden bullet" for the treatment of the varied presentation of ARDS, it remains our contention that basic management principles of ARDS must continue to emphasize an aggressive approach to the identification and treatment of the septic focus while all efforts are concurrently exploited to reduce the potentially aggravating effects of secondary injury on microvascular function. Currently research into the diagnosis, prevention, and treatment of nosocomial pneumonia is an example of how secondary injury may be minimized in ALI. Further, it is important to recognize the potentially detrimental effects of various therapies on the microvascular membrane in ARDS.
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Critical care clinics · Oct 1988
ReviewTherapeutic strategies for acute hypoxemic respiratory failure.
Acute hypoxemic respiratory failure is a pulmonary capillary leak state that occurs in many different clinical settings. The resultant edema causes refractory hypoxemia due to intrapulmonary shunting and loss of lung compliance. Mechanical ventilation with PEEP and high concentrations of supplemental oxygen are frequently necessary for patient survival, but these therapies may themselves contribute to further lung damage. ⋯ The use of these combined modalities for pediatric patient care has been discussed. Finally, other approaches to treatment currently being investigated in animal models of AHRF have been presented. As these and other new treatment methods are explored, hopefully it will be possible to decrease the unacceptably high mortality rate still encountered in AHRF.
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Critical care clinics · Oct 1988
ReviewBronchopulmonary dysplasia in the pediatric intensive care unit.
Bronchopulmonary dysplasia (BPD) is an important cause of chronic respiratory disease in infants and children. Infants with BPD are frequently readmitted to the hospital during the first 2 years of life usually because of infectious exacerbations of their chronic lung disease. This article is a review of the multisystem pathology of BPD and therapeutic approaches to the management of these infants in the PICU.