Critical care clinics
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Critical care clinics · Jan 2024
ReviewCardiogenic Shock: Pathogenesis, Classification, and Management.
Cardiogenic shock (CS) is a life-threatening circulatory failure syndrome which can progress rapidly to irreversible multiorgan failure through self-perpetuating pathophysiological processes. Recent developments in CS classification have highlighted its etiologic, mechanistic, and hemodynamic heterogeneity. Optimal CS management depends on early recognition, rapid reversal of the underlying cause, and prompt initiation of hemodynamic support.
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Critical care clinics · Jan 2024
ReviewManagement of Arrhythmias in the Cardiovascular Intensive Care Unit.
Arrhythmias in the cardiovascular intensive care unit (CVICU) can be difficult to manage because of the complex hemodynamic and respiratory states of critically ill patients. Treating physicians must be educated to prevent, diagnose, and treat a multitude of tachyarrhythmias and bradyarrhythmias. In this review article, the authors outline a pragmatic approach to patient assessment, arrhythmia diagnosis, and management of the most common arrhythmias seen in the CVICU.
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Critical care clinics · Jan 2024
ReviewCongenital Heart Disease in the Adult Cardiac Intensive Care Unit.
This article provides a broad overview of key concepts and more commonly encountered critical illness presentations in adult congenital heart disease (ACHD) patients. General principles are discussed, and the need for ACHD subspecialty consultation is emphasized. ACHD is categorized based on hemodynamic profile, and common clinical presentations are reviewed, including common pitfalls. Many ACHD lesions are associated with predictable complications, and awareness of these associations can guide evaluation and management, which are listed in this article.
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Critical care clinics · Jan 2024
ReviewEnd-of-Life Planning in Patients with Mechanical Circulatory Support.
There are a growing number of patients with mechanical circulatory support (MCS) in the setting of bridge to transplant and destination therapy and temporary support. Preparedness planning is an important aspect of care that involves device-specific Goals of Care and Advance Care Planning and should ideally be used in MCS candidates before initiation of therapy and revisited periodically. The withdrawal of both temporary and durable MCS can be complex and controversial.
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Critical care clinics · Jul 2023
ReviewDevelopment of the Modern Cardiothoracic Intensive Care Unit and Current Management.
The modern cardiothoracic intensive care unit (CTICU) developed as a result of advances in critical care, cardiology, and cardiac surgery. Patients undergoing cardiac surgery today are sicker, frailer, and have more complex cardiac and noncardiac morbidities. CTICU providers need to understand postoperative implications of different surgical procedures, complications that can occur in CTICU patients, resuscitation protocols for cardiac arrest, and diagnostic and therapeutic interventions such as transesophageal echocardiography and mechanical circulatory support. Optimum CTICU care requires a multidisciplinary team with collaboration between cardiac surgeons and critical care physicians with training and experience in the care of CTICU patients.