Current opinion in critical care
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Curr Opin Crit Care · Apr 2009
ReviewPractical management of acute liver failure in the Intensive Care Unit.
Acute liver failure is an uncommon condition affecting about 2500 patients each year in the United States. Optimal medical management in the ICU is one of the more important factors impacting survival with or without liver transplantation. This review focuses on the practical aspects of the management of patients with acute liver failure in the ICU. ⋯ The careful management of the patient in the ICU with acute liver failure improves the likelihood of survival.
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Acute cor pulmonale is a form of acute right heart failure produced by a sudden increase in resistance to blood flow in the pulmonary circulation, which is now rapidly recognized by bedside echocardiography. ⋯ As a general rule, the treatment consists in rapidly reducing resistance to blood flow in the pulmonary circulation, obtained by a specific strategy according to etiology.
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The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential adverse effects. ⋯ The use of NMBAs in acute lung injury/ARDS patients is not marginal. Recent studies suggest a beneficial effect of early use of NMBAs on oxygenation and inflammation. The role of NMBAs in the occurrence of ICU-acquired neuromyopathies and lung atelectasis in ARDS patients remains largely questioned. The use of NMBAs in the early phase of ARDS could reinforce the beneficial effects of a lung-protective ventilation. In this context, the effect of NMBAs on the outcome of ARDS patients must be evaluated.
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Pleural effusions (PLEF) occur frequently in mechanically ventilated patients (MVP). There have been improvements in bedside diagnosis, quantification, and drainage techniques. Nevertheless, information on the impact of PLEF on heart-lung performance and pathophysiologic considerations for drainage in MVP is limited. ⋯ PLEF drainage does not always improve oxygenation in MVP with acute respiratory failure. An assessment of chest wall compliance and a lung recruitment maneuver may help predict the response. Procedural complication risks should be considered when choosing the best approach.