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1.
Crit Care ; 27(1): 190, 2023 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-37193993

RESUMO

The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients.


Assuntos
Cuidados Críticos , Microcirculação , Ressuscitação , Cuidados Críticos/tendências , Hemodinâmica , Inteligência Artificial
2.
J Intensive Care Soc ; 23(2): 162-169, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35615232

RESUMO

The COVID-19 pandemic of 2020 imposed significant strain on critical care services worldwide. The South London region experienced the largest numbers of critical care admissions in the United Kingdom with King's College Hospital one of the busiest centres. This article outlines, using a descriptive narrative, the significant changes that occurred within King's Critical Care as a result of the pandemic and the decisions that were taken to provide effective co-ordination and control to the expanded service, in part drawing on the military experience of two of the authors. The wider context of crisis and major incident leadership and management is also discussed contrasting different approaches used in civilian and military settings.

3.
J R Nav Med Serv ; 99(3): 151-3, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24511805

RESUMO

Conducting research in the deployed environment is challenging but if the various obstacles are overcome then the data captured can be vital in developing future treatment strategies. Perhaps the most important aspect is having an enthusiastic individual who is dedicated to research and can thus concentrate on maximising the potential of this unique environment.


Assuntos
Pesquisa Biomédica , Enfermagem de Cuidados Críticos , Unidades de Terapia Intensiva , Enfermagem Militar , Pesquisa Biomédica/organização & administração , Humanos , Desenvolvimento de Programas , Reino Unido
4.
J Org Chem ; 66(18): 6141-50, 2001 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-11529743

RESUMO

The 1alpha-fluoro A-ring phosphine oxide 1, a useful building block for fluorinated vitamin D analogues, was synthesized from (S)-carvone in 13 synthetic steps, and only five isolations, in 22% overall yield. In the key synthetic step, a highly selective palladium-catalyzed isomerization of dieneoxide 18 to dieneol 20 was achieved using an appropriately selected fluorinated alcohol as a catalytic proton source.


Assuntos
Óxidos/síntese química , Fosfinas/síntese química , Terpenos/química , Vitamina D/análogos & derivados , Álcoois/química , Monoterpenos Cicloexânicos , Monoterpenos , Óxidos/química , Paládio/química , Fosfinas/química , Vitamina D/síntese química
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