caa a22 4500 475801547 CHVBK 20180406123738.0 cr unu---uuuuu 170329e20000601xx s 000 0 eng 10.1007/s002689910107 doi (NATIONALLICENCE)springer-10.1007/s002689910107 Overview of Modern Management of Patients with Critical Injury and Severe Sepsis [Elektronische Daten] [Stephen J. Streat, Lindsay D. Plank, Graham L. Hill] Abstract.: Over the last 10 years there have been substantial changes in the issues confronting intensivists and surgeons caring for critically ill patients. A substantial increase in the number of elderly patients with surgical illness and complex co-morbidity has accompanied the increase in the proportion of elderly in populations in the developed world. This phenomenon has been seen particularly with sepsis. Incidence rates for blunt trauma have declined overall, but the problems of the elderly trauma patient have become more evident. Major elective surgery remains a common indication for short-term intensive care in many countries, but the need for cost-containment has led to increased use of high-dependency care for many such patients. Expectations of both society and clinicians have increased, and this has been reflected in the increased demand for complex procedures (e.g., liver transplantation, cerebral artery aneurysm clipping, aortic aneurysm repair) in patients previously considered at too high risk. Along with these expectations have come pressures on clinicians to reduce costs at the same time as improving clinical outcomes. Despite many advances in the care of critically ill patients with injury or sepsis, mortality, morbidity, and cost remain high; and nutritional support is frequently required. The duration and extent of the metabolic changes seen in response to critical surgical illness and intensive care treatments have become better characterized. Although some of the changes in body water and fat are modifiable, loss of large amounts of (functional) protein has been resistant to various strategies so far studied. 2000 by the Société Internationale de Chir, 2000 Streat Stephen J. Department of Critical Care Medicine, Auckland Hospital, Auckland 1003, New Zealand, New Zealand aut Plank Lindsay D. University Department of Surgery, Auckland Hospital, Fifth Floor, Private Bag 92-024, Auckland 1003, New Zealand, New Zealand aut Hill Graham L. University Department of Surgery, Auckland Hospital, Fifth Floor, Private Bag 92-024, Auckland 1003, New Zealand, New Zealand aut World Journal of Surgery Springer-Verlag 24/6(2000-06-01), 655-663 0364-2313 24:6<655 2000 24 268 https://doi.org/10.1007/s002689910107 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910107 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Streat Stephen J. Department of Critical Care Medicine, Auckland Hospital, Auckland 1003, New Zealand, New Zealand aut NATIONALLICENCE 700 1- Plank Lindsay D. University Department of Surgery, Auckland Hospital, Fifth Floor, Private Bag 92-024, Auckland 1003, New Zealand, New Zealand aut NATIONALLICENCE 700 1- Hill Graham L. University Department of Surgery, Auckland Hospital, Fifth Floor, Private Bag 92-024, Auckland 1003, New Zealand, New Zealand aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/6(2000-06-01), 655-663 0364-2313 24:6<655 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer