Current opinion in critical care
-
Curr Opin Crit Care · Oct 2004
ReviewNonlinear dynamics, complex systems, and the pathobiology of critical illness.
The review considers problems in critical illness and critical care in the context of complex systems science. Normal physiology is characterized by nonlinear dynamics, and it appears that the pathophysiology of critical illness alters those dynamics. ⋯ Physiologic dynamics in health and in critical illness appear to reflect complex, interconnected systems biology. Alterations in illness and during recovery may provide important clues to the underlying structure of the system. With knowledge of the structure, therapy could be better focused toward supporting both function and dynamics, offering hope for improved outcomes.
-
Severe sepsis and septic shock are common and deadly conditions for which the epidemiology, pathogenesis, and management continue to evolve. Recent publications (2003 and early 2004) have been systematically reviewed for important new original research and scholarly reviews, with an emphasis on clinical advances in adults. ⋯ The works reviewed reflect the advances in the care of patients with sepsis.
-
Curr Opin Crit Care · Oct 2004
ReviewCurrent status of blood component therapy in surgical critical care.
The use of blood component therapy, with transfusion of red cells, plasma, and platelets, is common in critical care. New evidence has emerged documenting the risks associated and lack of efficacy or improvement in clinical outcome with blood transfusion for the treatment of anemia in critically ill patients who are hemodynamically stable. ⋯ Current data regarding blood transfusion thresholds and risks of blood transfusion have not as yet significantly altered practice patterns. Efforts to reduce blood transfusion rates in critically ill patients are required. These strategies will require education, unit and institutional protocols, and reduction of phlebotomy for diagnostic laboratory testing in the intensive care unit. Further investigations regarding anemia in critical care and new treatment and prevention strategies are required.
-
Elevated levels of cardiac troponins, indicative of the presence of cardiac injury, have been reported in critically ill patients. In this review, the incidence, significance, and clinical relevance of elevated troponin levels among this group of patients will be discussed. ⋯ Elevated troponin levels are not only present in patients suffering from acute coronary syndromes but can also be present in critically ill patients. Even minor elevations are specific for myocardial injury. However, every elevated troponin level in the critically ill patient should not be rigorously diagnosed or treated as a myocardial infarction.