Abstract:
:Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients are still significant. Cardiovascular disease accounts for much of the mortality in long-term survivors; screening before the transplant procedure and adequate control of hypertension should help improve patient survival. Many of the gastrointestinal complications are due to overimmunosuppression and sepsis. Adequate management must include withdrawal of all immunosuppressive medications in order to save the patient's life. Liver disease is usually of viral origin; patients with chronic active hepatitis or cirrhosis should remain on dialysis. Chronic rejection is the major cause of graft loss in long-term survivors; it is unresponsive to antirejection treatment and its progression may be mediated by nonimmunologic mechanisms. Correctable problems such as renal artery stenosis and ureteral obstruction should be ruled out before a late deterioration in graft function is disregarded as chronic rejection. Post-transplant diabetes, osteonecrosis, cataracts, and nephrotoxicity are directly related to the various immunosuppressive drugs currently used. The lowest dose compatible with graft acceptance should help reduce the incidence of these nonfatal but significant complications. Recurrence of disease is a common histologic finding in many transplant recipients but, except for a few diseases such as HUS, FSGS, and oxalosis, it usually does not lead to graft failure. Successful transplantation restores fertility in many uremic patients. Adequate counseling on contraception is imperative in order to avoid unwanted pregnancies and to delay parenthood for at least 1 year. Current immunosuppressive agents are not teratogenic, no dose adjustments are necessary, and an ill-advised decrease in medication may precipitate a rejection episode. Premature delivery is the major problem in these patients and can be avoided by maintaining adequate graft function and controlling hypertension and infections. It is evident from this review that most of the long-term morbidity and mortality seen in renal allograft recipients are due to overimmunosuppression with sepsis or to side effects of the individual drugs, steroids being a common denominator in almost all cases. New immunosuppressive protocols must aim not only to improve patient and graft survival but also to avoid the many complications that limit the full rehabilitation of these patients.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Fabrega AJ,Lopez-Boado M,Gonzalez Ssubject
Has Abstractpub_date
1990-10-01 00:00:00pages
979-1005issue
4eissn
0749-0704issn
1557-8232journal_volume
6pub_type
杂志文章,评审abstract::As scientists and physicians have gained sophistication in understanding and treating illness, our view of disease has changed in scope. We appreciate more fully the diverse and wide-ranging effects of stress on the ability of the organism to maintain homeostasis. As our study of the failure of homeostasis has advance...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-10-01 00:00:00
abstract::The known metabolic abnormalities and nutritional requirements of the brain injury, spinal cord injury, and acute stroke patient have been presented. Further investigations are required in all these conditions to identify specific nutritional requirements and metabolic abnormalities. The specific role of nutritional s...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-01-01 00:00:00
abstract::This article reviews principles in the rational use of antibiotics in sepsis and septic shock and presents evidence-based recommendations for optimal antibiotic therapy. Every patient with sepsis and septic shock must be evaluated at presentation before the initiation of antibiotic therapy. However, in most situations...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2009.08.004
更新日期:2009-10-01 00:00:00
abstract::Timely performance and accurate interpretation of portable chest radiographs in the ICU setting are fundamental components of quality care. Teamwork between intensive care clinicians and radiologists is necessary to assure that the appropriate studies, of high technical quality, are obtained. By working together to in...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1994-04-01 00:00:00
abstract::The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The mai...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-01-01 00:00:00
abstract::Alterations in hemostasis are common in patients with cancer admitted to the ICU. Depending on the underlying disease and specific hemostatic abnormality, the patient with cancer may develop bleeding, thrombosis, or both, such as DIC. Bleeding complications usually result from abnormalities in platelets or deficiency ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70200-1
更新日期:2001-07-01 00:00:00
abstract::Acute renal failure continues to be a common occurrence in critically ill cancer patients. It frequently results from a combination of risk factors, which include the following: hemodynamic alterations associated with renal ischemia; exposure to nephrotoxic drugs; urinary tract obstruction; and specific abnormalities ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-01-01 00:00:00
abstract::Proper care of the severely injured patient will require the development of a new anesthesia specialist. The trauma anesthesiologist, like the cardiovascular anesthesiologist, must become thoroughly familiar with one disease. The anesthesiologist who manages patients with traumatic disease must become an expert in cri...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract::The pathophysiology of the burn injury and treatment factors that influence burn depth are explained. Details of burn wound care, including indications for early excision, topical antimicrobials, and the most recent advances in skin substitutes, are described. Burn wound sepsis, the most common and serious complicatio...
journal_title:Critical care clinics
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract::The EMR in the ICU has the utility of providing the necessary information to make sound clinical decisions for critically ill patients. For it to be optimized, the EMR must be more than just what is being replicated in the written record or merely a documentation tool; it must add value that supports and enhances clin...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70068-3
更新日期:1999-07-01 00:00:00
abstract::This article reviews two important innovations in echocardiography resulting from the recent advances in the capabilities of microprocessors. The first, automatic endocardial border detection, has been implemented on computers contained entirely within echocardiograph machines and is gaining wide clinical use. The sec...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70256-6
更新日期:1996-04-01 00:00:00
abstract::Metabolic acid-base disturbances commonly and predictably complicate the course of many intensive care unit patients and plague the intensivists, surgeons, and anesthesiologists beset with the task of caring for them. In this article, we offer a systematic approach to the patient with the metabolic acid-base disorders...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-10-01 00:00:00
abstract::Although much has been accomplished in HTx and LTx in the past few decades, much remains to be conquered. It is an ever-changing, always fascinating field. Though science and technology know no limits, the primary limitation of HTx and LTx continues to be the availability of donor organs. One can only hope that furthe...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(02)00054-4
更新日期:2003-04-01 00:00:00
abstract::Cardiopulmonary arrest during pregnancy is a rare event that critical care clinicians must be prepared to manage. The causes of cardiopulmonary arrest during pregnancy, recommended modifications to cardiopulmonary resuscitation protocols that are specific to pregnancy, indications for and timing of perimortem cesarean...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2004.05.005
更新日期:2004-10-01 00:00:00
abstract::Approximately 12,000 Americans suffer traumatic spinal cord injuries each year. This article discusses the management of their neurologic, respiratory, cardiovascular, gastroenterologic, and genitourinary complications in the critical care setting. ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1986-10-01 00:00:00
abstract::The recent development of valid and reliable assessment tools to monitor agitation, sedation, analgesia, and delirium in the ICU represents an essential first step in the provision of patient comfort and the development of preferred treatment strategies. To make the ICU a more humane healing environment, these assessm...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70189-5
更新日期:2001-10-01 00:00:00
abstract::This article summarizes the biomechanical relationship of the spinal column to load stresses with respect to column failure, and the resulting associated central nervous system injury. In addition, it presents pertinent animal research, which has focused onto the development standardized animal spinal cord injury mode...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-07-01 00:00:00
abstract::The optimal management of arterial blood pressure in the setting of acute stroke has not been firmly defined. The different types of stroke--ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage--have different pathophysiologies and require different approaches in terms of blood pressure management in the ac...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2006.08.002
更新日期:2006-10-01 00:00:00
abstract::Traumatic brain injury is a common occurrence in the United States, leading to approximately 190,000 deaths or long-term disabilities. Following the primary insult, secondary disturbances in cerebral blood flow (CBF) and metabolism may have deleterious effects on potentially viable neurons. Recent studies evaluating C...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70300-6
更新日期:1997-01-01 00:00:00
abstract::An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2018.06.002
更新日期:2018-10-01 00:00:00
abstract::Dementia is a terminal illness that leads to progressive cognitive and functional decline. As the elderly population grows, the incidence of dementia in hospitalized older adults increases and is associated with poor short-term and long-term outcomes. Delirium is associated with an accelerated cognitive decline in hos...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2020.08.010
更新日期:2021-01-01 00:00:00
abstract::This article provides a background so that the intensivist can appreciate the social and cultural context in which the AIDS epidemic developed. The upheaval that AIDS has caused in the gay community is described along with some of the economic effects AIDS has had on that population and on the practice of medicine, bo...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1993-01-01 00:00:00
abstract::Arterial catheterization is used frequently in the management of critically ill patients, both for continuous blood pressure monitoring and access to the arterial circulation to obtain frequent blood gas measurements. The procedure is usually easily accomplished at the bedside using percutaneous methods such as the Se...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1992-10-01 00:00:00
abstract::Improving the course and outcome of patients with ARDS presents a considerable challenge. An important component of meeting this challenge is a more comprehensive understanding of the heterogeneous pathophysiology of ARDS and the biologic response of the individual patient. This understanding may be developed through ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(03)00072-1
更新日期:2002-01-01 00:00:00
abstract::Summarizing the mission of the ICU, the institution directive board and the unit director must generate a structure, proceedings criteria, management, and analysis of results capable of providing satisfactory care. Furthermore, they must take into account each organizational aspect that is necessary to offer an approp...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2006.04.002
更新日期:2006-07-01 00:00:00
abstract::Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specifi...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2010.06.009
更新日期:2010-10-01 00:00:00
abstract::For well over a decade, intensive care unit (ICU) telemedicine programs have been providing care to patients and families and an invaluable service to many receiving sites that are otherwise outside the traditional reach of high-quality critical care. It will be important that during this growth, outcomes regarding th...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2019.02.006
更新日期:2019-07-01 00:00:00
abstract::Brain injury represents the major cause of long-term disability and mortality among patients resuscitated from cardiac arrest. Brain-directed therapies include maintenance of normal oxygenation, hemodynamic support to optimize cerebral perfusion, glycemic control, and targeted temperature management. Pertinent guideli...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2014.06.007
更新日期:2014-10-01 00:00:00
abstract::The provision of care to the CCI patient is complex, challenging, and unique. The advanced practice nursing model at Mount Sinai Hospital is one successful care delivery model that fills the needs of both CCI patients and the nurses who work with them. The following transferable aspects of the RCU add to the unit's su...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(02)00008-8
更新日期:2002-07-01 00:00:00
abstract::The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care seda...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2009.05.001
更新日期:2009-07-01 00:00:00