Ugeskrift for laeger
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SIRS, sepsis, severe sepsis, and septic shock are complex syndromes ranging from early signs of infection to multiple organ dysfunction and shock. The reported incidence of sepsis is as high as 35% with mortality rates from 27% to 54% in sepsis and septic shock, respectively. Though aetiology and pathogenesis can vary significantly between septic patients, emphasis has been made to preserve sepsis as a clinical diagnosis ensuring high sensitivity. Since 2001 several new treatment strategies have been implemented, but early diagnosis, optimization of haemodynamics, rapid identification of pathogen and adequate antibiotic treatment are still of the highest importance.
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Ugeskrift for laeger · Feb 2007
Review[Antibiotic strategies in the treatment of infection in critically ill patients].
Inappropriate antimicrobial therapy of pneumonia, severe sepsis and bacteraemia is associated with high mortality. Adjustment of insufficient initial antibiotics after susceptibility testing does not reduce mortality. ⋯ The initial broad-spectrum should be narrowed according to bacterial susceptibility data. This evidence-based intervention ensures appropriate antimicrobial treatment to critically ill patients to improve outcome and reduction of the use of broad-spectrum antibiotics.
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The practice of paediatric intensive care has matured dramatically over the past 20 years with improving intensive care unit mortality rates and a positive effect on child survival. This paper gives an overview of many of these aspects, and attempts to present a picture of the present situation in Denmark. ⋯ In Denmark, critically ill children are cared for in at least 27 primarily adult intensive care units by nurses and doctors who are not specifically trained in paediatric intensive care. Suggestions for a more centralisation of paediatric intensive care in Denmark are made.
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Critical care research has facilitated the development of clinical guidelines to improve the outcome of critically-ill patients. The high mortality needs to be reduced further, by means of increased research to the benefit of patients, relatives and society. Clinicians, researchers, public officials and politicians at all levels must work together towards this aim.
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The neurointensive care unit provides observation and treatment of acute, life-threatening disorders of and injuries to the central and peripheral nervous system. The primary aim of care is the prevention of secondary neuronal damage; this requires a highly multidisciplinary approach, involving neuromonitoring as well as management of systemic comorbidity and complications. This article presents major pathophysiological issues specific to neurointensive care, as well as recent advances in the management of the critically-ill neurosurgical and neurological patient.