Hospital practice (1995)
-
Nutrition support is important in critical illness, and accurate recording is particularly important to determine whether nutritional goals are met both from a caloric and volume perspective. ⋯ This study highlights the importance of accurate nutritional monitoring in the ICU and demonstrates that educational interventions can improve enteral feeding protocols. Pump calibrations, frequent interrogation and vigilant nutritional documentation can improve enteral nutrition delivery. Future studies are needed to determine if the effects are sustainable and if further education will further improve documentation and delivery.
-
Hospital practice (1995) · Jan 2015
ReviewGlycemic control in the critically ill: What have we learned since NICE-SUGAR?
Since publication of the Normoglycemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation trial in 2009, demonstrating increased 90-day mortality in a large cohort of critically ill patients treated with the intensive, rather than moderate blood glucose (BG) target, enthusiasm has dampened for 'tight glucose control' in intensive care units. Nevertheless, a burgeoning literature has clarified limitations of the interventional trials of intensive insulin therapy in the critically ill and explored key clinical aspects of glycemic control in this population. This review provides an overview of the last 6 years of research in this field. Topics include advances in understanding the domains of glycemic control - hyperglycemia, hypoglycemia and glucose variability; the role of diabetic status in modulating the relationship of these domains of control to mortality; the importance of premorbid glucose control in patients with diabetes; the central role that measurement frequency has in determining success in achieving desired BG control and, finally, new data exploring time in targeted BG range, a potentially 'unifying' metric.
-
Undertreatment of pain (oligoanalgesia) in the emergency department is common, and it negatively impacts patient care. Both failure of appropriate pain assessment and the potential for unsafe analgesic use contribute to the problem. As a result, achieving satisfactory analgesia while minimizing side effects remains particularly challenging for emergency physicians, both in the emergency department and after a patient is discharged. ⋯ Other pharmacological therapies have been shown to be effective for certain pain modalities, such as the use of antidepressants for musculoskeletal pain, γ-aminobutyric acid agonists for neuropathic and postsurgical pain, antipsychotics for headache, and topical capsaicin for neuropathic pain. Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture. Tailoring of available treatment options to specific pain modalities, as well as improvements in pain assessment, treatment options, and formulations, may improve pain control in the emergency department setting and beyond.
-
Hospital practice (1995) · Jan 2015
ReviewObstructive sleep apnea in the perioperative setting: complications and management strategies.
Obstructive sleep apnea (OSA) is frequently encountered in an undiagnosed, untreated state in perioperative patients. It increases the risk of respiratory, cardiac, and infectious complications following surgical procedures. ⋯ Herein, we discuss data regarding perioperative outcomes in patients with OSA, methods to quickly identify patients at high risk for OSA, and implementation of clinical safeguards to minimize OSA-associated complications. An algorithm is provided to guide the perioperative management of patients with OSA.
-
Hospital practice (1995) · Jan 2015
ReviewCurrent and developing strategies for monitoring and reversing direct oral anticoagulants in patients with non-valvular atrial fibrillation.
In light of the increasing clinical utilization of the direct oral anticoagulants (DOACs) among patients with non-valvular atrial fibrillation, this review evaluates strategies for monitoring and reversing the anticoagulant effect of these agents. ⋯ While evidence-based recommendations cannot be definitively provided for management of DOAC-related bleeding events at present, several targeted reversal agents are currently in development, and hold promise for solving this important clinical problem.