scholarly journals Znacaj profilakse akutne mukozne lezije kod pacijenata u jedinici intenzivnog lecenja

2007 ◽  
Vol 54 (1) ◽  
pp. 47-50 ◽  
Author(s):  
N.M. Popovic
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Direct Consequence ◽  
Severe Trauma ◽  
Mucosal Lesion ◽  
Critically Ill Patient ◽  
Multiple Risk Factors ◽  
Massive Gastrointestinal Bleeding ◽  
Mucosal Lesions ◽  
Clinically Significant

At least three-quarters of critically ill patients develop mucosal lesion as a direct consequence of stress within the first 24 hours following the admission to intensive care unit. These mucosal lesions occur as superficial or deep mucosal lesions which can lead to massive gastrointestinal bleeding and it can put at risk the life of critically ill patient. There are multiple risk factors for the occurence of mucosal lesion such as: respiratory failure requiring mechanical ventilation, sepsis, hypotension, burns, severe trauma, neurotrauma, ileus, coagulopathy, renal and hepatic failure, myocardial infarction etc. The incidence of silent (ocult) bleeding in critically ill patients is almost 100%, but only about 5% of patients have clinically apparent (overt) hemorrhage and 1-2% have clinically significant bleeding which requires blood transfusions. In patients who are at the greatest risk of developing mucosal lesion, prophylactic treatment ought to be started immediately in order to achieve pH4 with adequate perfusion and coagulation. Today several groups of medications are used for the prevention of mucosal gastrointestinal lesion and they include: antacids, sucralfate, hisamine-2 receptor antagonists and proton pump inhibitors.

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals T3 as predictor of mortality in any cause non-critically ill patient

2021 ◽  
Author(s):  
Erika Biegelmeyer ◽  
Iury Scanagata ◽  
Laura Alves ◽  
Murilo Reveilleau ◽  
Fernando Pereira Schwengber ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critically Ill Patient ◽  
Total Serum ◽  
Population Total ◽  
Low T3 ◽  
Serum T3 ◽  
Overall Mortality

Background: Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. Objective: To evaluate the prevalence and predictive value of low T3 levels on 30 days- and six month-term mortality in non-critically ill patients. Secondary outcomes evaluated length of hospital stay, overall mortality, and hospital readmission. Design: Prospective cohort study. Methods: 345 consecutive patients from Internal medicine ward of a tertiary hospital in southern Brazil included from October 2018 to April 2019 and followed for 6 months. Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day hospital mortality. Results: Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-days hospital mortality (15.1% versus 4.1%, p<0.001) and higher 6-months overall mortality (31.7% versus 13.2%, p<0.001). Total serum T3 at admission was an independent predictor of 30-days hospital mortality. Conclusion: Low T3 levels are a prevalent condition among non-critically ill patients and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification, and should be further employed in this setting.

Cardiovascular System in the Critically Ill Patient

2019 ◽  
pp. 26-34
Author(s):  
Juan G. Ripoll Sanz ◽  
Norlalak Jiramethee ◽  
Jose L. Diaz-Gomez
Keyword(s):  
Cardiac Output ◽  
Cardiovascular System ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Integrated System ◽  
Critically Ill Patient ◽  
Cardiovascular Disorders ◽  
Output Control ◽  
System 2

This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.

Interpretation and implication of diastolic dysfunction in critically ill patients

2017 ◽  
Author(s):  
Claire Colebourn ◽  
Jim Newton
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Left Ventricular ◽  
Left Ventricular Filling ◽  
Critically Ill Patient ◽  
Severe Illness ◽  
Ventricular Relaxation ◽  
Ventricular Filling

This chapter looks at the interpretation of parameters of diastolic function in the critically ill patient. It provides a guide to interpretation and how to avoid misinterpretation of these parameters in the context of severe illness. The assessment of left ventricular relaxation and left ventricular filling pressures are described in detail.

Transport of the critically ill patient

2017 ◽  
Author(s):  
Laura Flutter ◽  
Christoph Melzer-Gartzke ◽  
Claudia Spies ◽  
Julian Bion
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Best Practice ◽  
Ad Hoc ◽  
Critically Ill Patient ◽  
National Guidelines ◽  
Specialist Services ◽  
Hospital Transfer ◽  
Safe Transport

The safe transport of critically ill patients is recognized internationally as a key competency for clinicians working in anaesthesia, critical care, and emergency medicine. This includes inter- and intra-hospital, land, and air transport. The centralization of specialist services and growing demand for critical care beds have increased pressure on hospitals to provide transfer support for critically ill patients. A variety of systems have emerged to facilitate the increasing need for both inter- and intra-hospital transfer of patients, ranging from a national coordinated retrieval service to the ad hoc utilization of on-call teams. The potential for complications during all types of transfer has been well documented. In order to improve safety, a number of national guidelines and courses have been developed to provide a standardized approach to transfer medicine. This chapter reviews the current literature on the subject and provides a summary of best practice for the transfer of the critically ill patient.

scholarly journals Muscle wasting in the critically ill patient: how to minimise subsequent disability

2020 ◽  
Vol 81 (4) ◽  
pp. 1-9
Author(s):  
Luke Flower ◽  
Zudin Puthucheary
Keyword(s):  
Critically Ill ◽  
Psychological Health ◽  
Critically Ill Patients ◽  
Muscle Wasting ◽  
Critically Ill Patient ◽  
Muscle Loss ◽  
Post Discharge ◽  
Mortality And Morbidity ◽  
Muscle Breakdown ◽  
Physical And Psychological Health

Muscle wasting in critically ill patients is the most common complication associated with critical care. It has significant effects on physical and psychological health, mortality and quality of life. It is most severe in the first few days of illness and in the most critically unwell patients, with muscle loss estimated to occur at 2–3% per day. This muscle loss is likely a result of a reduction in protein synthesis relative to muscle breakdown, resulting in altered protein homeostasis. The associated weakness is associated with in an increase in both short- and long-term mortality and morbidity, with these detrimental effects demonstrated up to 5 years post discharge. This article highlights the significant impact that muscle wasting has on critically ill patients' outcomes, how this can be reduced, and how this might change in the future.

Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

1991 ◽  
Vol 2 (4) ◽  
pp. 639-656 ◽  
Author(s):  
Robert E. Dupuis ◽  
Jorge Miranda-Massari
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

Anion Gap, Anion Gap Corrected for Albumin, and Base Deficit Fail to Accurately Diagnose Clinically Significant Hyperlactatemia in Critically Ill Patients

2008 ◽  
Vol 23 (2) ◽  
pp. 122-127 ◽  
Author(s):  
Lakhmir S. Chawla ◽  
Dhiraj Jagasia ◽  
Lynn M. Abell ◽  
Michael G. Seneff ◽  
Melinda Egan ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Base Deficit ◽  
Anion Gap ◽  
Clinically Significant

scholarly journals Effect of Persistent Thrombocytopenia on Mortality in Surgical Critical Care Patients

2016 ◽  
Vol 23 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Qin Wu ◽  
Jianan Ren ◽  
Gefei Wang ◽  
Guanwei Li ◽  
Nadeem Anjum ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surgical Critical Care ◽  
Hospital Stays ◽  
Clinically Significant ◽  
The Relationship ◽  
Persistent Thrombocytopenia

Thrombocytopenia is common among surgical critically ill patients. The relationship between the duration of thrombocytopenia and mortality is not well studied. This retrospective 12-month cohort study was designed to evaluate the association between persistent thrombocytopenia and mortality among surgical critically ill patients to determine the risk factors for persistent thrombocytopenia. The study included adult patients consecutively admitted to the surgical intensive care unit (SICU) at our institution. Patients with a diagnosis of thrombocytopenia were identified from a prospective critical care database. We defined patients with persistent thrombocytopenia as those with thrombocytopenia lasting more than 7 consecutive days. The primary outcome of this study was 28-day mortality and the secondary outcomes were lengths of SICU stay and hospital stay. Fifty-one patients experienced persistent thrombocytopenia and 71 experienced nonpersistent thrombocytopenia. Among patients with persistent thrombocytopenia, mortality was significantly higher, and SICU and hospital stays were longer than those with nonpersistent thrombocytopenia. Risk factor analysis failed to predict which patients with thrombocytopenia would develop into persistent thrombocytopenia. Persistent thrombocytopenia is a clinically significant disorder and is associated with poorer outcomes. Future studies are needed to further define this process.

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