Early Warning Systems for Critical Illness Outside the Intensive Care Unit
Early warning systems (EWSs) are designed and deployed to create a rapid assessment and response for patients with clinical deterioration outside the intensive care unit (ICU). These models incorporate patient-level data such as vital signs and laboratory values to detect or prevent adverse clinical events, such as vital signs and laboratories to allow detection and prevention of adverse clinical events such as cardiac arrest, intensive care transfer, or sepsis. The applicability, development, clinical utility, and general perception of EWS in clinical practice vary widely. Here, we review the field as it has grown from ea...
Source: Critical Care Clinics - April 21, 2024 Category: Intensive Care Authors: Katharine E. Henry, Heather M. Giannini Source Type: research
Critical Illness Outside the Intensive Care Unit: Research Challenges in Emergency and Prehospital Settings
Patients with acute critical illness require prompt interventions, yet high-quality evidence supporting many investigations and treatments is lacking. Clinical research in this setting is challenging due to the need for immediate treatment and the inability of patients to provide informed consent. Attempts to obtain consent from surrogate decision-makers can be intrusive and lead to unacceptable delays to treatment. These problems may be overcome by pragmatic approaches to study design and the use of supervised waivers of consent, which is ethical and appropriate in situations where there is high risk of poor outcome and...
Source: Critical Care Clinics - April 21, 2024 Category: Intensive Care Authors: Stephen Macdonald, Daniel Fatovich, Judith Finn, Edward Litton Source Type: research
Advanced Critical Care Techniques in the Field
Critical care principles and techniques continue to hold promise for improving patient outcomes in time-dependent diseases encountered by emergency medical services such as cardiac arrest, acute ischemic stroke, and hemorrhagic shock. In this review, the authors discuss several current and evolving advanced critical care modalities, including extracorporeal cardiopulmonary resuscitation, resuscitative endovascular occlusion of the aorta, prehospital thrombolytics for acute ischemic stroke, and low-titer group O whole blood for trauma patients. Two important critical care monitoring technologies —capnography and ultrasoun...
Source: Critical Care Clinics - April 17, 2024 Category: Intensive Care Authors: Elizabeth Powell, Alex P. Keller, Samuel M. Galvagno Source Type: research
In-Hospital Triage
This article reviews these concepts and methods of in-hospital triage. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 16, 2024 Category: Intensive Care Authors: Manoj L. Karwa, Ali Abbas Naqvi, Melanie Betchen, Ajay Kumar Puri Source Type: research
Intensive Care Unit Without Walls
Critical illness is a continuum with different phases and trajectories. The “Intensive Care Unit (ICU) without walls” concept refers to a model whereby care is adjusted in response to the patient’s needs, priorities, and preferences at each stage from detection, escalation, early decision making, treatment and organ support, followed by recovery and rehabilitation, wi thin which all healthcare staff, and the patient are equal partners. The rapid response system incorporates monitoring and alerting tools, a multidisciplinary critical care outreach team and care bundles, supported with education and training, analytica...
Source: Critical Care Clinics - April 16, 2024 Category: Intensive Care Authors: Guy Glover, Victoria Metaxa, Marlies Ostermann Source Type: research
The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure
Intermediate care (IC) is used for patients who do not require the human and technological support of the intensive care unit (ICU) yet require more care and monitoring than can be provided on general wards. Though prevalent in many countries, there is marked variability in models of organization and staffing, as well as monitoring and interventions provided. In this article, the authors will discuss the historical background of IC, review the impact of IC on ICU and IC patient outcomes, and highlight where future studies can shed light on how to optimize IC organization and outcomes. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 16, 2024 Category: Intensive Care Authors: Aaron S. Case, Chad H. Hochberg, David N. Hager Source Type: research
Critical Care in the Austere Environment
This article describes the current practice of critical care medicine in the austere environment, using recent natural disasters, pandemics, and conflicts as case studies. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 12, 2024 Category: Intensive Care Authors: Spencer Lord, Jarone Lee Source Type: research
Diagnosis and Management of Acute Respiratory Failure
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 2, 2024 Category: Intensive Care Authors: Philip Yang, Annette M. Esper Source Type: research
Copyright
ELSEVIER (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 2, 2024 Category: Intensive Care Source Type: research
Contributors
GREGORY S. MARTIN, MD, Msc (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 2, 2024 Category: Intensive Care Source Type: research
Contents
Philip Yang and Annette M. Esper (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 2, 2024 Category: Intensive Care Source Type: research
Forthcoming Issues
Critical Illness Outside the ICU (Source: Critical Care Clinics)
Source: Critical Care Clinics - March 2, 2024 Category: Intensive Care Source Type: research
Invasive Mechanical Ventilation
Invasive mechanical ventilation allows clinicians to support gas exchange and work of breathing in patients with respiratory failure. However, there is also potential for iatrogenesis. By understanding the benefits and limitations of different modes of ventilation and goals for gas exchange, clinicians can choose a strategy that provides appropriate support while minimizing harm. The ventilator can also provide crucial diagnostic information in the form of respiratory mechanics. These, and the mechanical ventilation strategy, should be regularly reassessed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - February 9, 2024 Category: Intensive Care Authors: Jennifer C. Szafran, Bhakti K. Patel Source Type: research
Physical and Cognitive Impairment in Acute Respiratory Failure
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post –intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This rev...
Source: Critical Care Clinics - February 7, 2024 Category: Intensive Care Authors: Jonathan Taylor, Mary Elizabeth Wilcox Source Type: research
Fluid Management in Acute Respiratory Failure
Fluid management in acute respiratory failure is an area of uncertainty requiring a delicate balance of resuscitation and fluid removal to manage hypoperfusion and avoidance of hypoxemia. Overall, a restrictive fluid strategy (minimizing fluid administration) and careful attention to overall fluid balance may be beneficial after initial resuscitation and does not have major side effects. Further studies are needed to improve our understanding of patients who will benefit from a restrictive or liberal fluid management strategy. (Source: Critical Care Clinics)
Source: Critical Care Clinics - February 6, 2024 Category: Intensive Care Authors: Shewit P. Giovanni, Kevin P. Seitz, Catherine L. Hough Source Type: research
