Ten to twenty percent of the patients hospitalized in an Intensive Care Unit (ICU) will require tracheostomy, either due to long term hospitalization or due to other medical conditions. The procedure itself, as well as the afterward care; carry a lot of potential complications for the patients, some of which may be preventable, if certain precautions are being taken. The decision for the type of the procedure, percutaneous tracheostomy or surgical tracheostomy along with the appropriate tracheostomy tube type is based on the individual characteristics of the patient, ie anatomical characteristics, clinical stability and expertise available. Continue reading
Patients admitted to Intensive Care Units (ICU) have the highest mortality rates among hospitalized patients. For those who survive, recovery is often a prolonged rehabilitation period with physical, cognitive and psychological dysfunction. The aim of the present narrative review was to identify in the existing literature articles providing information about the development of chronic pain after ICU stay. We performed a PubMed search for publications up to 22 March 2020. We identified 41 articles eligible to be included in the present review; 29 of them were original research articles. Pre-existing chronic pain, previous poor health- related quality of life (HRQoL), but also the critical illness itself and organ support with multiple interventions, predispose to the development of chronic pain in the post-critical period, making it difficult to return to the pre-disease functional status. Opioid administration during mechanical ventilation is a common practice, frequently without reliable and systematic assessment of pain or individualized titration of dosage. Continue reading
Damage control surgery is defined as rapid termination of an operation after control of life threatening bleeding and contamination in severely injured and unstable patients, followed by correction of physiologic abnormalities and de-finitive management. Emphasis then shifts from the operating theater to the intensive care unit, where the patient’s physiologic deficits are corrected.
Continue readingAcute and prolonged illness seems to result in a variety of different neuroendocrine alterations. During the acute phase of critical illness there is an actively secreting anterior pituitary gland and a peripheral resistance to anabolic hormones. In the chronic phase of critical illness there is a uniformly reduced secretion of anterior pituitary hormones, with the notable exception of cortisol.
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