Current opinion in critical care
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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.
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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.
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Curr Opin Crit Care · Oct 2004
ReviewSimulation in critical care and trauma education and training.
To review theory and practice of simulation technology in critical care and trauma training. ⋯ Simulation appears poised to revolutionize education, training, and credentialing in critical care, surgery, and anesthesiology. However, advances in computing and technology have outpaced the evaluative and validation studies of simulation-based education.
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Decisions made in critical care are often complicated, requiring an in-depth understanding of the relations between complex diseases, available interventions, and patients with a wide range of characteristics. Standard modeling techniques such as decision trees and statistical modeling have difficulty in capturing these interactions as the complexity of the problem increases. ⋯ Simulation models provide useful tools for organizing and analyzing the interactions between therapies, tradeoffs, and outcomes.