My blogs

Augmented renal clearance: when supranormal renal function may cause harm

Introduction Augmented renal clearance (ARC) is the phenomenon of enhanced renal function in critically ill patients. ARC is characterized by a higher than predicted increase in the renal elimination of solutes. It occurs due to an increase in glomerular filtration and altered renal tubular function, usually manifesting as an increase in the creatinine clearance. ARC… Continue reading Augmented renal clearance: when supranormal renal function may cause harm

Tracheostomy decannulation: what is the optimal approach?

Introduction Patients who undergo prolonged invasive mechanical ventilation and those with the inability to maintain airway and clear secretions require tracheostomy.  A tracheostomy becomes necessary in approximately 10% of critically ill patients who require invasive mechanical ventilation.1 Once the underlying illness has resolved, the patient must be evaluated for decannulation. The ability to maintain adequate spontaneous breathing… Continue reading Tracheostomy decannulation: what is the optimal approach?

Hyperlactatemia in critical illness: time for reappraisal? 

Lactic acidosis commonly occurs in the critically ill, especially among patients with shock of varying etiology. High lactate levels are uniformly associated with poor clinical outcomes, including mortality.1,2 However, there has been considerable interest and contradictory views regarding the clinical value of using lactate levels to guide resuscitation in critically ill patients. Although generally considered to… Continue reading Hyperlactatemia in critical illness: time for reappraisal? 

Delirium in the critically ill: time to awaken?

Introduction Delirium is an acute dysfunctional state of the brain, typically seen among critically ill patients. The characteristic clinical feature of delirium is a disturbance in attention that evolves rapidly, associated with cognitive impairment, and unrelated to the underlying disease process. Impaired memory and disorientation, with the impediment of speech and perception are also common… Continue reading Delirium in the critically ill: time to awaken?

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