Journal of intensive care medicine
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Lactic acidosis is frequently encountered in the intensive care unit. It occurs when there is an imbalance between production and clearance of lactate. Although lactic acidosis is often associated with a high anion gap and is generally defined as a lactate level >5 mmol/L and a serum pH <7.35, the presence of hypoalbuminemia may mask the anion gap and concomitant alkalosis may raise the pH. ⋯ The routine measurement of serum lactate, however, should not determine therapeutic interventions. Unfortunately, treatment options remain limited and should be aimed at discontinuation of any offending drugs, treatment of the underlying pathology, and maintenance of organ perfusion. The mainstay of therapy of lactic acidosis remains prevention.
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J Intensive Care Med · Jul 2005
ReviewCan we abandon daily routine chest radiography in intensive care patients?
Two different schools of thought exist on the utility of daily routine chest radiographs in intensive care unit (ICU) patients: some ICU physicians argue that daily routine chest radiographs are indicated in all patients who have cardiopulmonary problems or are receiving artificial ventilation. Others state that chest radiographs should be made on indication only, for example, following a change in clinical status or change of supportive devices. ⋯ A restrictive strategy has been compared with a daily routine strategy in only 2 clinical trials: 1 study conducted in a pediatric ICU (pediatric ICUs usually have low mortality rates), and the other a rather small (and probably underpowered) study. The debate about discontinuing daily routine chest radiographs in the ICU is still not settled.
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J Intensive Care Med · Jul 2005
Comparative Study Clinical TrialBispectral index monitoring during the administration of neuromuscular blocking agents in the pediatric intensive care unit patient.
Bispectral index (BIS) values were prospectively recorded in pediatric intensive care unit patients receiving continuous infusion of a neuromuscular blocking agent. Sedation was provided by a continuous infusion of midazolam or propofol. The BIS number was recorded by a bedside computer every 10 seconds but was concealed from health care workers. ⋯ Oversedation was more likely with propofol than midazolam. During the use of neuromuscular blocking agents, oversedation is a common occurrence. Physiologic parameters are not an accurate means of assessing the depth of sedation.
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J Intensive Care Med · Jul 2005
ReviewManagement of cardiogenic shock attributable to acute myocardial infarction in the reperfusion era.
Cardiogenic shock is the leading cause of death among patients hospitalized with acute myocardial infarction. It is defined as tissue hypoperfusion resulting from ventricular pump failure in the presence of adequate intravascular volume. ⋯ However, emergency percutaneous coronary intervention or coronary artery bypass graft surgery is required to decrease mortality rates. Novel approaches, including inhibition of nitric oxide synthase and new mechanical support devices, may further decrease mortality rates, which remain high despite reperfusion therapy.
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J Intensive Care Med · May 2005
ReviewRole of the interventional pulmonologist in the intensive care unit.
Interventional pulmonology is a new field within the pulmonary and critical care medicine specialty with a focus on invasive diagnostic and therapeutic modalities in airway and pleural disorders. The interventional pulmonologist is highly qualified to take a prominent role in the intensive care unit in a consultative fashion to provide assistance with pleural procedures, establishment and care of artificial airways, and management of patients with respiratory failure attributable to structural central airway disorders. The presence of a dedicated operator with advanced skills facilitates access to specialized procedures in an expeditious and safe manner. Clear communication between the interventional pulmonologist and intensivist is vital to ensure a collaborative effort that delivers optimal patient care.