Current opinion in critical care
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Curr Opin Crit Care · Dec 2006
ReviewFailure of nonoperative management of abdominal solid organ injuries.
Nonoperative management of the spleen has been the conventional approach for dealing with blunt splenic injury in children for 25 years. Following acceptance in the field of pediatric surgery, nonoperative management of blunt injury to the liver and spleen became the template in adult trauma surgery. It has proven to be of unequivocal benefit to the majority of hemodynamically stable pediatric and adult patients who have suffered blunt liver or splenic trauma. Offsetting these gains, has been the presence of failures. ⋯ Despite the failures of nonoperative management outlined in this review, the approach has been generally successful. Efforts at improving organ salvage rates and diminishing failures with this approach continue. Notwithstanding our enthusiasm to advance this method of patient care, we must avoid imperiling a subpopulation of patients in our attempt to improve nonoperative management success rates.
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To review recent advances in the definitions and diagnostic criteria for acute renal failure and acute kidney injury. To explore how these changes impact the epidemiology and clinical implications for patients in the intensive care unit. ⋯ Small changes in kidney function in hospitalized patients are important and impact on outcome. RIFLE criteria provide a uniform definition of acute kidney injury and are increasingly used in literature.
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Curr Opin Crit Care · Dec 2006
The evolving role of the acute care nurse practitioner in critical care.
The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective. ⋯ The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.
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Curr Opin Crit Care · Dec 2006
ReviewMeasurement of acid-base resuscitation endpoints: lactate, base deficit, bicarbonate or what?
Inadequate oxygen delivery to the tissues frequently results in significant metabolic acidosis. The resultant cellular and organ dysfunction can increase morbidity, mortality and hospital stay. Early diagnosis of shock can lead to early resuscitation efforts that can prevent ongoing tissue injury. This review focuses on the metabolic, hemodynamic and regional perfusion endpoints utilized in the diagnosis of metabolic acidosis resulting from shock. Resuscitation strategies aimed at supranormal oxygen delivery will be discussed. ⋯ Despite the large number of endpoints available to the clinician, none are universally applicable and none have independently demonstrated improved survival when guiding resuscitation. Patients who respond well to initial resuscitation efforts demonstrate a survival advantage over nonresponders.