February 2005 - Critical Care and Shock

Continuous renal replacement therapy in intensive care unit

Salim Lim 02/02/2005

Acute renal failure (ARF) requiring dialysis is a common complication of patients in intensive care unit (ICU). Dialysis can be performed with either intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT). CRRT is associated with less hemodynamic instability. Therefore, it is preferred in critically ill and hypotensive patients in ICU. However, current evidence does not demonstrate the superiority of CRRT over IHD.

Malignant bronchial tear: Emergency management

Salim Surani 02/02/2005

A 73-year-old man with history of metastatic esophageal cancer and esophageal stent placement 4 months prior presentation presented after a syncopal episode related to severe cough. On arrival to the emergency department he was unresponsive, hypoxemic and acidotic. The patient was orotracheally intubated. Computed tomography of chest revealed extensive consolidation involving the right lung. Significant air leak with returning was noted post intubation with tidal volumes that were less than 50% of the initial volume. The endotracheal tube was replaced with defected cuff noted.

“Natural catastrophes: Disaster management and implications for the acute care practitioner”

Ana G. Alzaga 02/02/2005

The year 2004 shook the world with earthquakes, hurricanes and Tsunamis in a way we would never imagine. Thousands of people died, were injured, missing or became homeless. Government agencies, health-care associations and citizens in general take part in planning for emergency preparedness and action when a natural disaster strikes a geographical area in such a devastating way. International humanitarian associations also participate in offering relief to the regions most critically affected.

The use of levosimendan in shocked patients with compromised left ventricular function and requiring catecholamine support – A case series

Anthony S. McLean 02/02/2005

Objective: Levosimendan is a calcium sensitizer that improves cardiac contractility without increasing intracellular calcium level, hence energy demand. Theoretically, it is safer to use levosimendan than catecholamine in shocked patients who require inotrope support. Studies on the use of levosimendan in shocked patients are, however, limited. In this case series, we describe the pre- and post-infusion effects of levosimendan in shocked patients with reduced cardiac function and requiring catecholamine inotrope support. Design: A case-series report.