Critical care : the official journal of the Critical Care Forum
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ICU-acquired limb and respiratory muscle weakness is a common, serious ICU syndrome, increasing in frequency with prolonged ICU stay and sepsis. A systematic approach facilitates precise localization of the problem within central or peripheral nervous system. ⋯ Muscle enzyme testing, electromyography-nerve conduction and muscle biopsy are valuable investigative tests. Nerve biopsy is less commonly needed, but is useful when vascultis is suspected.
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Comment
Genetic epidemiology of acute lung injury: choosing the right candidate genes is the first step.
In an innovative scientific review in this issue, Grigoryev and colleagues report a method for choosing candidate genes for acute lung injury (ALI) based on gene expression data derived from multiple animal models of mechanical ventilation and shear stress. The authors conclude there are five key biologic processes that warrant further investigation: inflammatory and immune responses, cell proliferation, chemotaxis, and blood coagulation. This review represents an important first step toward studying the genetic epidemiology of ventilator-induced lung injury and ALI. The application of these findings to future human studies of the genetic influence on ALI risks and outcomes is discussed here.
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Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. ⋯ Early tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients may help in reducing unnecessary resource utilization.
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Anaemia is a common problem in critically ill patients admitted to intensive care units. Many factors can be involved in its development, including rapid alterations of iron metabolism. ⋯ With the inflammatory process, iron distribution is disturbed, with decreased serum iron levels and increased iron stores. Little information is available on the precise role of alterations of iron metabolism in the development of iron anaemia in critically ill patients.
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Review
Clinical review: moral assumptions and the process of organ donation in the intensive care unit.
The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. ⋯ Organ donation has recently been described by intensivists in a morally neutral way as an "option" that they should "offer", as "part of good end-of-life care", to families of appropriate patients. In conclusion, the review shows that a rational utilitarian framework does not adequately encompass interpersonal interactions during organ donation. A morally neutral position frees intensivists to ensure that clinical and interpersonal processes in organ donation are performed to exemplary standards, and should more robustly reflect societal acceptability of organ donation (although it may or may not "produce more donors").