Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Selection of the optimal antimicrobial therapy is often crucial for the morbidity and mortality associated with an infection. A reliable antibiogram provides the basis for antibiotic therapy optimization. In case of life-threatening infections, minimal inhibitory concentration values should be available so that, in conjunction with knowledge of the pharmacokinetic properties of the respective antibiotics, a rational selection addressing the individual case is feasible. If only categorized results (susceptible, intermediate, resistant: S-I-R) are available, they should be established according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines in order to avoid therapeutic failures.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Tissue penetration of antibiotics. Does the treatment reach the target site?].
For critically ill patients, infections still imply a major challenge for the treating physician. One key factor of successful treatment is sufficient exposure of the employed antimicrobial agent at the site of infection. In most cases, this is the interstitial space of the infected organ or a body cavity; much rarer vital bacteria are located within body cells. ⋯ In order to use pharmacokinetic data to optimize the treatment of critically ill patients, critical appraisal of the causative pathogen, the location of the infection, and the source of the used pharmacokinetic data is necessary.
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Med Klin Intensivmed Notfmed · Apr 2014
[The respiratory therapist in the intensive care unit team].
Qualified respiratory therapists have been an integral part of the U. S. health care system for over 50 years now and are an indispensable part of the system. ⋯ Since 2005, the German Respiratory Society also offers nurses and physiotherapists training in respiratory therapy. The core competencies of the numerous intensive care respiratory therapists employed in German intensive care units include, among others, the diagnosis and treatment of acute and chronic respiratory failure, including invasive and non-invasive respiratory therapy, excessive secretion management, including bronchoscopic airway clearance, and inhalation therapy.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Tarragona strategy--appropriate antibiotic therapy in the ICU].
Appropriate antibiotic initial therapy remarkably decreases the mortality of patients with infections in the ICU. The establishment of an appropriate initial therapy follows empirical aspects. This practice was first done for the treatment of nosocomial pneumonia. Since that time the practice became known as Tarragona strategy. ⋯ This procedure is safe, reduces mortality, limits the development of resistance, and is economic.