Current opinion in critical care
-
Curr Opin Crit Care · Dec 2012
ReviewClinical Reflection: a vital process for supporting the development of wisdom in doctors.
This review explores in detail the practice of reflection and its importance for doctors. It offers a definition of and a framework for both oral and written Clinical Reflection. It presents a thorough and detailed explanation of Clinical Reflection, its meaning, purpose, and processes and provides an illustrative case example from critical care. ⋯ Clinical Reflection offers doctors a powerful way of supporting their professional development and providing evidence of their practical wisdom as expressed by Aristotle. It is time that an appropriate understanding of what reflection can offer doctors is explored more generally among the profession.
-
Acute kidney injury (AKI) is a clinical syndrome with many different causes. The Kidney Disease: Improving Global Outcomes consensus AKI definition has harmonized the study of AKI, yet effective clinical therapeutics are not available to treat most cases of AKI. In order to develop therapeutic interventions, an approach to AKI that subdivides the various causes of AKI into well codified subclasses of AKI may allow a process of 'disentanglement'. ⋯ Disentangling the AKI syndrome requires an approach of rigorous taxonomy, molecular diagnostics, and intense collaboration. This approach may be applied to other complex and heterogeneous syndromes like sepsis and acute respiratory distress syndrome as well, but this article only outlines this approach to AKI.
-
Acute kidney injury (AKI) in the ICU is associated with adverse outcomes. We review the long-term consequences of AKI in ICU patients. ⋯ Further research is necessary to delineate the mechanisms by which AKI may lead to CKD, and to understand how CKD enhances the risk for developing AKI. Whereas restrospective observational studies of this population exist, prospective clinical studies and trials evaluating the long-term clinical outcomes of AKI specifically in ICU patients are needed.
-
Curr Opin Crit Care · Dec 2012
ReviewResident full-time specialists in the ICU: a survivable model?
Intensivists have a professional and personal interest in trying to answer whether immediate review of patients by a consultant intensivist improves outcomes. Although some advocate in-hospital around-the-clock consultant intensivist presence, does the available evidence suggest all ICUs should be staffed in such a manner and is such a service sustainable given the shortage of intensivists, potential loss of staff from burnout and cost? ⋯ A unified staffing solution within a country's different ICUs, let alone between countries, is unlikely. The current evidence does not universally support or justify 24 h/7 days consultant intensivist presence. International differences in staffing models and ICU structures make direct comparisons difficult and in some circumstances the balance may favour 24 h/7 days consultant intensivists.
-
Curr Opin Crit Care · Dec 2012
ReviewManagement strategies for acute spinal cord injury: current options and future perspectives.
Spinal cord injury is a devastating acute neurological condition with loss of function and poor long-term prognosis. This review summarizes current management strategies and innovative concepts on the horizon. ⋯ General management strategies for acute spinal cord injury consist of protection of airway, breathing, oxygenation and control of blood loss with maintenance of blood pressure. Unstable spine fractures should be stabilized early to allow unrestricted mobilization of patients with spinal cord injuries and to decrease preventable complications. Steroids are largely considered obsolete and have been abandoned in clinical guidelines. Nogo-A represents a promising new pharmacological target to promote sprouting of injured axons and restore function. Prospective clinical trials of Nogo-A inhibition in patients with spinal cord injuries are currently under way.