Alexandre Joosten, Brenton Alexander, and Maxime Cannesson There is still no “universal” consensus on an optimal endpoint for goal directed therapy (GDT) in the critically ill patient. As in other areas of medicine, this should help providers to focus on a more “individualized approach” rather than a protocolized approach to ensure proper patient care. Hemodynamic optimization needs more than simply blood pressure, heart rate, central venous pressure and

urine output monitoring. It is essential to also monitor flow variables (cardiac output/stroke volume) and dynamic parameters of fluid responsiveness whenever available. This article will provide a review of current and trending approaches of the goals of resuscitation Epacadostat purchase in the critically ill patient. Andre L. Holder and Gilles Clermont The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. When primary variables are collected

with high enough frequency http://www.selleckchem.com/products/blu9931.html to derive new variables, this data hierarchy can be used to develop physiologic signatures. The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes. Ian J. Barbash and Jeremy M. Kahn Hemodynamic instability and for shock are important causes of mortality worldwide. Improving outcomes for these patients through effective resuscitation is a key

priority for the health system. This article discusses several organizational approaches to improving resuscitation effectiveness and outlines key areas for future research and development. The discussion is rooted in a conceptual model of effective resuscitation based on three domains: monitoring systems, response teams, and feedback mechanisms. Targeting each of these domains in a unified approach helps clinicians effectively treat deteriorating patients, ultimately improving outcomes for this high-risk patient group. Index 177 “
“In primary care, there has been a move to share tasks and responsibilities traditionally reserved for the primary care provider (PCP) with other members of the patient care team, including medical assistants, nurses, pharmacists, patent educators and coaches [1]. This team approach is a central feature of the widely promoted primary care medical home (PCMH) model which has been successful in improving quality of care and patient satisfaction while holding down costs [2], [3], [4], [5] and [6]. Concern has been raised regarding the impact of the ‘team approach’ on the quality of the physician–patient relationship [7].