End-of-Life Planning in Patients with Mechanical Circulatory Support
There are a growing number of patients with mechanical circulatory support (MCS) in the setting of bridge to transplant and destination therapy and temporary support. Preparedness planning is an important aspect of care that involves device-specific Goals of Care and Advance Care Planning and should ideally be used in MCS candidates before initiation of therapy and revisited periodically. The withdrawal of both temporary and durable MCS can be complex and controversial. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 7, 2023 Category: Intensive Care Authors: Katie P. Truong, James N. Kirkpatrick Source Type: research
Cardiogenic Shock
Cardiogenic shock (CS) is a life-threatening circulatory failure syndrome which can progress rapidly to irreversible multiorgan failure through self-perpetuating pathophysiological processes. Recent developments in CS classification have highlighted its etiologic, mechanistic, and hemodynamic heterogeneity. Optimal CS management depends on early recognition, rapid reversal of the underlying cause, and prompt initiation of hemodynamic support. (Source: Critical Care Clinics)
Source: Critical Care Clinics - July 5, 2023 Category: Intensive Care Authors: Dhruv Sarma, Jacob C. Jentzer Source Type: research
Mechanical Ventilation
Critical care and mechanical ventilation have a relatively brief history in medicine. Premises existed through the seventeenth to nineteenth centuries but modern mechanical ventilation started in the twentieth century. Noninvasive ventilation techniques had started both in the intensive care unit and for home ventilation at the end of the 1980s and the 1990s. The need for mechanical ventilation is increasingly influenced worldwide by the spread of respiratory viruses, and the last coronavirus disease 2019 pandemic has seen a massive successful use of noninvasive ventilation. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: Laurent J. Brochard Source Type: research
Critical Care 1950 to 2022
Critical care units —designed for concentrated and specialized care—came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. After WWII, medical practic e and education promoted further specialization. Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room’s level of observation and specialized nursing to serve the critically ill, wheth er medic...
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: D. Kirk Hamilton, Jeanne Kisacky, Frank Zilm Source Type: research
Thinking Clearly
Brain dysfunction during critical illness (ie, delirium and coma) is extremely common, and its lasting effect has only become increasingly understood in the last two decades. Brain dysfunction in the intensive care unit (ICU) is an independent predictor of both increased mortality and long-term impairments in cognition among survivors. As critical care medicine has grown, important insights regarding brain dysfunction in the ICU have shaped our practice includ ing the importance of light sedation and the avoidance of deliriogenic drugs such as benzodiazepines. Best practices are now strategically incorporated in targeted...
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: Kimberly F. Rengel, Matthew F. Mart, Jo Ellen Wilson, E. Wesley Ely Source Type: research
Critical Care Pharmacists
Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a k...
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: Andrea Sikora Source Type: research
Palliative Care in the Intensive Care Unit: Past, Present, and Future
In this article, the authors review the origins of palliative care within the critical care context and describe the evolution of symptom management, shared decision-making, and comfort-focused care in the ICU from the 1970s to the early 2000s. The authors also review the growth of interventional studies in the past 20 years and indicate areas for future study and quality improvement for end-of-life care among the critically ill. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: James Downar, May Hua, Hannah Wunsch Source Type: research
Development of the Modern Cardiothoracic Intensive Care Unit and Current Management
The modern cardiothoracic intensive care unit (CTICU) developed as a result of advances in critical care, cardiology, and cardiac surgery. Patients undergoing cardiac surgery today are sicker, frailer, and have more complex cardiac and noncardiac morbidities. CTICU providers need to understand postoperative implications of different surgical procedures, complications that can occur in CTICU patients, resuscitation protocols for cardiac arrest, and diagnostic and therapeutic interventions such as transesophageal echocardiography and mechanical circulatory support. Optimum CTICU care requires a multidisciplinary team with co...
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: Ronald G. Pearl, Sheela Pai Cole Source Type: research
Afterword It Was a Different World Then … Ramblings from an Early Intensivist on Care and Quality Measures
My introduction, to what was to become Intensive Care, came in 1964 when I became the junior member of staff of the “Respiration Unit” in Oxford. The unit was part of the Neurology Department but was run, jointly, by John Spalding, a neurologist, and Alex Crampton Smith, an anesthetist. They had been working together for over 10 years and had distilled their research and experiences into Clinical Practice and Physiology of Artificial Respiration, one of the earliest books on Intensive Care.1 (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: John H. Kerr Source Type: research
History of Critical Care Medicine
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Authors: Hannah Wunsch Source Type: research
Copyright
ELSEVIER (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Source Type: research
Contributors
GREGORY S. MARTIN, MD, MSC (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Source Type: research
Contents
Hannah Wunsch (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Source Type: research
Forthcoming Issues
Data Science in Critical Care (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 24, 2023 Category: Intensive Care Source Type: research
Machine Learning of Physiologic Waveforms and Electronic Health Record Data
Perioperative morbidity and mortality are significantly associated with both static and dynamic perioperative factors. The studies investigating static perioperative factors have been reported; however, there are a limited number of previous studies and data sets analyzing dynamic perioperative factors, including physiologic waveforms, despite its clinical importance. To fill the gap, the authors introduce a novel large size perioperative data set: Machine Learning Of physiologic waveforms and electronic health Record Data (MLORD) data set. They also provide a concise tutorial on machine learning to illustrate predictive m...
Source: Critical Care Clinics - May 18, 2023 Category: Intensive Care Authors: Sungsoo Kim, Sohee Kwon, Mia K. Markey, Alan C. Bovik, Maxime Cannesson Source Type: research
