Critical care medicine
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Critical care medicine · Jul 2009
Physician attitudes toward regionalization of adult critical care: a national survey.
Regionalization has been proposed as a method to improve outcomes for patients with critical illness. We sought to determine intensivist physician attitudes and potential barriers to the regionalization of adult critical care. ⋯ Intensivist physicians have mixed opinions about regionalization, with little consensus about whether regionalization will improve outcomes. Most felt that regionalization will improve patient outcomes, but many expressed concerns about unintended adverse consequences. Respondents identified several barriers and potential implementation strategies that can help policymakers design a regionalized system of critical care in the United States.
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Critical care medicine · Jul 2009
ReviewTherapeutic hypothermia after cardiac arrest in clinical practice: review and compilation of recent experiences.
We sought to review findings from recent literature on the postresuscitation care of cardiac arrest patients using therapeutic hypothermia as part of nontrial treatment. ⋯ The survival and neurological outcomes benefit from therapeutic hypothermia are robust when compared over a wide range of studies of actual implementation.
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Critical care medicine · Jul 2009
ReviewTherapeutic hypothermia for acute myocardial infarction: past, present, and future.
Therapeutic hypothermia has been shown in randomized clinical trials to improve neurologic outcomes following cardiac arrest. Whether therapeutic hypothermia improves important outcomes after acute myocardial infarction is an area of active research. Here we review recent experimental and clinical data that examine whether therapeutic hypothermia can improve functional outcomes or mortality rate in acute myocardial infarction. We conclude that the available clinical evidence does not support therapeutic hypothermia as standard therapy for acute myocardial infarction.
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Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. ⋯ However, there are no prospective randomized trials demonstrating the benefit of fever control in these patient populations, and important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential risks of prolonged fever control.
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Critical care medicine · Jul 2009
ReviewMethods of cooling: practical aspects of therapeutic temperature management.
To review traditional and newer means of inducing, maintaining, and withdrawing therapeutic hypothermia and normothermia. To suggest treatment algorithms for temperature modulation and review neuromonitoring options. ⋯ Intensivists should be familiar with techniques to induce, maintain, and withdraw therapeutic temperature management, and select the most appropriate method for a given patient and situation.