Current opinion in critical care
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Advance care planning and palliative care interventions can improve the quality of end-of-life care by reducing unwanted high intensity care at the end of life. This may have important economic implications and may reduce the financial burden of patients' families. We review the literature to examine the impact advance care planning and palliative care has on ICU utilization, specifically ICU admissions and ICU length of stay (LOS), and to provide insight into ways to reduce costs and financial burden of care while simultaneously improving quality of care. ⋯ Advance care planning and palliative care can reduce ICU utilization at the end of life. The degree to which reducing ICU utilization decreases emotional and financial burden of end-of-life care for patients and families is unknown.
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Curr Opin Crit Care · Dec 2014
ReviewApproaches to patients and families with strong religious beliefs regarding end-of-life care.
End-of-life (EOL) decisions with limitations are made daily in ICUs around the world and may involve between 2 and 22% of patients admitted to an ICU. EOL decisions may be affected by numerous factors, including location and religion. This review aims to determine an approach to patients and families with strong religious views. ⋯ Through proper open communication and understanding of the patient's and/or family's views on EOL care and involvement of religious leaders, decisions can be made regarding how to further care for the patient.
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Curr Opin Crit Care · Dec 2014
ReviewSepsis-induced acute kidney injury revisited: pathophysiology, prevention and future therapies.
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with increased morbidity and mortality. Sepsis is the most common cause of AKI. Considerable evidence now suggests that the pathogenic mechanisms of sepsis-induced AKI are different from those seen in other causes of AKI. This review focuses on the recent advances in this area and discusses possible therapeutic interventions that might derive from these new insights into the pathogenesis of sepsis-induced AKI. ⋯ An understanding of the pathologic mechanisms of sepsis-induced AKI emphasizes the important role of maladaptive responses to the septic insult. Preventive and therapeutic measures should be based on counteracting these maladaptive responses of tubular epithelial cells, inflammation, and microvascular dysfunction.
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Curr Opin Crit Care · Dec 2014
ReviewDiagnosis of acute kidney injury: Kidney Disease Improving Global Outcomes criteria and beyond.
Acute kidney injury (AKI) is common. Clear criteria and accurate diagnostic tools are essential to diagnose AKI early and correctly. The aims of this review are to outline some of the pitfalls of the Kidney Disease Improving Global Outcomes (KDIGO) classification and to describe other traditional and novel tools to diagnose AKI. ⋯ Knowledge about the strengths and weaknesses of traditional diagnostic tests is essential to make the correct diagnosis of AKI. New tests and technical innovations offer the prospect of diagnosing AKI earlier and more accurately.
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Sepsis has a high morbidity, with a mortality rate of over 50% in the septic shock patient. This review provides a comprehensive summary of the latest Surviving Sepsis Campaign and the recent evidence since its publication. The guidelines reflect literature from the past 5 years to optimize outcomes in patients with severe sepsis and septic shock. ⋯ Severe sepsis remains a significant cause of morbidity and mortality in hospitalized patients. The International Surviving Sepsis Guidelines provide a framework for early recognition and treatment of this condition, with the goal of an improved outcome and mortality in severe sepsis. The recent evidence suggests that early identification, adequate volume resuscitation, and assessment of adequate circulation may be the key elements to decrease morbidity from severe sepsis and septic shock.