Articles: cations.
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Critical care nurse · Feb 2024
Insulin Infusion Protocols for Blood Glucose Management in Critically Ill Patients: A Scoping Review.
Continuous insulin infusion is a method for maintaining blood glucose stability in critically ill patients with hyperglycemia. Many insulin infusion protocols have been applied in intensive care units. Understanding the content of these protocols can help clinical staff choose the most appropriate and convenient protocol and promote best practices in managing glucose levels in critically ill adult patients. ⋯ Nurse-led guidelines must be based on the best available evidence and should include other variables related to glucose management (eg, patient disease type, medication, and nutrition) in addition to insulin infusion.
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Anesthesia and analgesia · Feb 2024
ReviewDepth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050.
Anesthesia objectives have evolved into combining hypnosis, amnesia, analgesia, paralysis, and suppression of the sympathetic autonomic nervous system. Technological improvements have led to new monitoring strategies, aimed at translating a qualitative physiological state into quantitative metrics, but the optimal strategies for depth of anesthesia (DoA) and analgesia monitoring continue to stimulate debate. Historically, DoA monitoring used patient's movement as a surrogate of awareness. ⋯ Generally, nociceptive monitors outperform basic clinical vital sign monitoring in reducing perioperative opioid use. This manuscript describes pupillometry, surgical pleth index, analgesia nociception index, and nociception level index, and suggest how future developments could impact their use. The final section of this review explores the profound implications of future monitoring technologies on anesthesiology practice and envisages 3 transformative scenarios: helping in creation of an optimal analgesic drug, the advent of bidirectional neuron-microelectronic interfaces, and the synergistic combination of hypnosis and virtual reality.
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Anesthesia and analgesia · Feb 2024
ReviewBeyond the Echo: The Evolution and Revolution of Ultrasound in Anesthesia.
This article explores the evolving role of ultrasound technology in anesthesia. Ultrasound emerged decades ago, offering clinicians noninvasive, economical, radiation-free, and real-time imaging capabilities. It might seem that such an old technology with apparent limitations might have had its day, but this review discusses both the current applications of ultrasound (in nerve blocks, vascular access, and airway management) and then, more speculatively, shows how integration of advanced ultrasound modalities such as contrast-enhanced imaging with virtual reality (VR), or nanotechnology can alter perioperative patient care. This article will also explore the potential of robotics and artificial intelligence (AI) in augmenting ultrasound-guided anesthetic procedures and their implications for medical practice and education.
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The extent to which different measures of back pain impact represent an underlying common factor has implications for decisions about which one to use in studies of pain management and estimating one score from others. ⋯ Scores of each measure can be estimated from the others for use in research.
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Curr Opin Crit Care · Feb 2024
ReviewVentilation during extracorporeal gas exchange in acute respiratory distress syndrome.
Accumulating evidence ascribes the benefit of extracorporeal gas exchange, at least in most severe cases, to the provision of a lung healing environment through the mitigation of ventilator-induced lung injury (VILI) risk. In spite of pretty homogeneous criteria for extracorporeal gas exchange application (according to the degree of hypoxemia/hypercapnia), ventilatory management during extracorporeal membrane oxygenation (ECMO)/carbon dioxide removal (ECCO 2 R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support. ⋯ The best compromise between reduction of native lung ventilatory load, extracorporeal gas exchange efficiency, and strategies to preserve lung aeration deserves further investigation.