Current opinion in critical care
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Curr Opin Crit Care · Dec 2014
ReviewRecent developments in the assessment of the multiply injured trauma patient.
To provide an update on the recent developments and controversies in the assessment of the traumatically injured patient. ⋯ The recent advances in the assessment of the multiply injured patient allow clinicians to more efficiently diagnose a patient's injuries and implement treatment in a more timely manner.
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Curr Opin Crit Care · Dec 2014
ReviewDefault options in the ICU: widely used but insufficiently understood.
Default options dramatically influence the behavior of decision makers and may serve as effective decision support tools in the ICU. Their use in medicine has increased in an effort to improve efficiency, reduce errors, and harness the potential of healthcare technology. ⋯ Defaults in the ICU may help or harm patients and clinical efficiency depending on their format and use. When constructing and encountering defaults, providers should be aware of their powerful and complex influences on decision making. Additional evaluations of the appropriate creation of healthcare defaults and their resulting intended and unintended consequences are needed.
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Acute kidney injury (AKI) is a frequent and serious event associated with a high rate of complications, with an increased risk of progression to multiple organ dysfunction and excessive 'attributable' mortality. AKI affects all physiologic functions and organ systems with interrelated mechanisms, including the 'classical' consequences of the uremic state, the inflammatory nature of AKI per se and resulting systemic effects, the modulating effect of AKI in the presence of an (inflammatory) underlying disease process and the multiple untoward effects induced by renal replacement therapy (RRT) and anticoagulation. ⋯ These systemic phenomena associated with AKI induce distant organ injury affecting all organ systems with clinically the most relevant effects being exerted on the lungs, the intestines and liver and the heart and predispose the progression to multiple organ dysfunction syndrome and death. Currently available renal replacement therapy modalities are incapable of compensating for these systemic consequences of AKI.
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Curr Opin Crit Care · Oct 2014
ReviewVeno-arterial extracorporeal membrane oxygenation for adult cardiovascular failure.
To examine the utility and technical challenges of applying veno-arterial extracorporeal membrane oxygenation for acute cardiovascular failure in adults with acute and chronic causes of heart failure. ⋯ Veno-arterial extracorporeal membrane oxygenation is an expensive, complex, resource intensive support. It is essential that its future use be guided by evidence obtained from centres that have demonstrated timely, safe support.
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This review aims to evaluate the latest versions of the Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score and Mortality Probability Model scores, make comparisons and describe their strengths and limitations. Additionally, we provide critical analysis and recommendations for the use of these scoring systems in different scenarios. ⋯ ICU scoring systems provide a valuable framework to characterize patients' severity of illness for the evaluation of ICU performance, for quality improvement initiatives and for benchmarking purposes. However, to ensure the best accuracy, constant updates as well as regional customizations are required.