Critical care medicine
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Critical care medicine · Jul 2008
ReviewOrganizational characteristics of the austere intensive care unit: the evolution of military trauma and critical care medicine; applications for civilian medical care systems.
Critical care in the U. S. military has significantly evolved in the last decade. More recently, the U. ⋯ This intensivist-directed team model provides sophisticated critical care even in the most austere environments. To optimize critically injured patients' outcomes, intensive care organizational models similar to the U. S. military, described in this article, can possibly be adapted to those of civilian care during disaster management to meet the challenges of emergency mass critical care.
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Critical care medicine · Jul 2008
Multicenter StudyRisk factors for albicans and non-albicans candidemia in the intensive care unit.
To determine risk factors for bloodstream infections (BSI) with Candida non-albicans (C-NA) species and Candida albicans (CA) among critically ill patients. ⋯ We found multiple common risk factors for both non-C. albicans and C. albicans BSIs, however we could not differentiate between these two groups based on clinical characteristics alone.
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Critical care medicine · Jul 2008
ReviewCritical care in the austere environment: providing exceptional care in unusual places.
War and other disasters are inexorably linked to illness and injury. As a consequence of this, healthcare providers will be challenged to provide advanced physiological support to preserve human life. Given the mobility and modularity of modern medical systems, the ability to provide critical care outside of the confines of traditional hospitals under such circumstances has become not only a reality and periodic necessity, but an expectation. Austerity amplifies the complexity of providing high-level critical care, because resources are frequently limited, providers are asked to fill unexpected roles determined by necessity, security may be threatened, and the population at risk and their afflictions can be highly diverse. ⋯ Adherence to sound, evidence-based, routine practice, within bounds of the circumstances, must underscore everything.
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Renal replacement therapy has been used by the U.S. Army at the combat support hospital echelon of care since the Korean conflict. Although there has been a general decline in the incidence of wartime acute kidney injury, the mortality associated with acute kidney injury and the use of renal replacement therapy remain unchanged, in the range of 60% to 80%. The U.S. Army official doctrine is that field dialysis is provided through a specialized Hospital Augmentation Team; however, this team has not been deployed to either Iraq or Afghanistan as a result of the ability to rapidly evacuate most cases requiring renal replacement therapy. The history of wartime renal replacement therapy is reviewed along with the general epidemiology of battlefield acute kidney injury and renal replacement therapy. ⋯ Acute kidney injury requiring renal replacement therapy in wartime casualties is an uncommon occurrence but one with extremely high mortality. Future doctrine should be prepared for contingencies in which the incidence may be increased as a result of mass crush injury casualties or prolonged evacuation times.
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Critical care medicine · Jul 2008
ReviewDamage control resuscitation: a sensible approach to the exsanguinating surgical patient.
The current wars in Iraq and Afghanistan have resulted in the highest rates of combat casualties experienced by the U.S. military since the Vietnam conflict. These casualties suffer wounds that have no common civilian equivalent and more frequently require massive transfusion (greater than 10 units of packed red blood cells [PRBCs] in less than 24 hrs) than civilian injured. ⋯ Review of the published support for this strategy reveals that additional trials are needed to study and optimize these techniques.