Missouri medicine
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Acute Respiratory Distress Syndrome (ARDS) is defined by bilateral diffuse infiltrates on chest radiography, a PO2/FiO2 ratio < 200, and noncardiogenic pulmonary edema. Pathophysiologically it is characterized by disruption of the alveolar lining and capillary endothelium, alveolar edema, protein exudation coupled with a marked inflammatory response and subsequent fibrosis and a resultant ventilation-perfusion mismatch. Effective treatment strategies include low tidal volume ventilation with positive end expiratory pressure, careful fluid management and good supportive care.
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Abdominal compartment syndrome (ACS) is seen with increasing frequency in the critically-ill. Elevated intraabdominal pressures interfere with vital organ function and contribute to mortality. ⋯ Measurement of bladder pressures plays a critical role in diagnosis and guiding therapy. Treatment includes non-invasive and invasive methodologies designed to decrease the volume of abdominal contents and invasive methods to increase the compartment dimensions.
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Immune-enhancing nutrition, or "immunonutrition," refers to the use of specialized nutrients, including glutamine, alanine, omega-3 fatty acids, and others, that help regulate the body's response to illness and injury. Clinical studies have demonstrated some very specific benefits, including fewer infectious complications and shorter length of hospitalization, in certain populations including high-risk surgical patients, trauma victims, and the critically-ill. Nationally recognized guidelines support the use of immune-enhancing nutrition in high-risk patients.
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The management of traumatic brain injury has changed as a result of evidence-based treatment guideline first established in 1995. They have promoted standardization of care and as a result improved outcomes. In addition, the guidelines have helped identify gaps in our knowledge-base that can direct future research efforts.