Current opinion in critical care
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Curr Opin Crit Care · Oct 2008
ReviewHemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques.
The present review will discuss the usefulness of ultrasound in the ICU in assessing hemodynamic instability in various critical care conditions. We will discuss how to interpret echocardiographic findings in critically ill patients including the physiological consequences of mechanical ventilation. ⋯ Echocardiography is now an unavoidable tool in assessing hemodynamic instability in the ICU. Echocardiography is complementary to a pulmonary artery catheter in the management of critical care patients. Echocardiography training is crucial to help its widespread use in all ICUs.
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To critically examine the mortality rates of septic shock over the last 25 years to determine if significant improvements have been accomplished. ⋯ Survival rates for patients in septic shock have gradually improved in critical care units worldwide over the last 25 years. Further improvement will be predicated on the discovery of new therapies to disrupt the underlying pathophysiology of sepsis and the development of improved rapid, diagnostic testing and immune monitoring of individual patients.
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Curr Opin Crit Care · Oct 2008
ReviewOutcome prediction in critical care: the Simplified Acute Physiology Score models.
Outcome prediction models measuring severity of illness of patients admitted to the intensive care unit should predict hospital mortality. This review describes the state-of-the-art of Simplified Acute Physiology Score models from the clinical and managerial perspectives. Methodological issues concerning the effects of differences between new samples and original databases in which the models were developed are considered. ⋯ Comparisons of intensive care unit performance should take into account not only the patient severity of illness, but also the effect of the 'intensive care unit variable', that is, differences in human resources, structure, equipment, management and organization of the intensive care unit. In the future, moving from patient and geographical area adjustment to resource use could allow the user to adjust for differences in healthcare provision.
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Congestion causes the majority of hospitalizations for heart failure and contributes to heart failure progression and mortality. Intravenous loop diuretics reduce the signs and symptoms of congestion. Loop diuretics, however, may be associated with increased morbidity and mortality because of deleterious effects on neurohormonal activation, electrolyte balance, and cardiac and renal function. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients. ⋯ In decompensated heart failure, ultrafiltration safely produces greater weight and fluid loss than intravenous diuretics, reduces rehospitalization rates for heart failure and is an effective alternative therapy.
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Curr Opin Crit Care · Oct 2008
ReviewOutcome prediction in critical care: the Mortality Probability Models.
The comparison of morbidity, mortality, and length-of-stay outcomes in patients receiving critical care requires adjustment based on their presenting illness. These adjustments are made with severity-of-illness models. These models must be periodically updated to reflect current medical practices. This article will review the history of the Mortality Probability Model (MPM), discuss why and how it was recently updated, and outline examples of MPM use. ⋯ Understanding appropriate application of models such as MPM is important as transparency in healthcare drives demand for severity-adjusted outcomes data.