Intensive care medicine
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Intensive care medicine · Apr 2010
Multicenter StudyCombination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia.
To assess the effect on survival of macrolides or fluoroquinolones in intubated patients admitted to the intensive care unit (ICU) with severe community-acquired pneumonia (severe CAP). ⋯ Patients with severe community-acquired pneumonia had a low adherence with the 2007 IDSA/ATS guidelines. Combination therapy with macrolides should be preferred in intubated patients with severe CAP.
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Intensive care medicine · Apr 2010
ReviewSystematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration.
Unrecognised or untreated clinical deterioration can lead to serious adverse events, including cardiopulmonary arrest and unexpected death. Paediatric alert criteria aim to identify children with early signs of physiological instability that precede clinical deterioration so that experienced clinicians can intervene with the aim of reducing serious adverse events and improving outcome. ⋯ Evidence supporting the validity, reliability and utility of paediatric alert criteria is weak. Studies are needed to determine which physiological parameters or combinations of parameters, best predict serious adverse events. Prospective evaluation of validity, reliability and utility is then needed before widespread adoption into clinical practice can be recommended.
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Intensive care medicine · Apr 2010
Randomized Controlled TrialPersisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality.
Pentraxin 3 (PTX3) is an inflammatory mediator produced by neutrophils, macrophages, myeloid dendritic and endothelial cells. During sepsis a massive inflammatory activation and coagulation/fibrinolysis dysfunction occur. PTX3, as a mediator of inflammation, may represent an early marker of severity and outcome in sepsis. ⋯ Persisting high levels of circulating PTX3 over the first days from sepsis onset may be associated with mortality. PTX3 correlates with severity of sepsis and with sepsis-associated coagulation/fibrinolysis dysfunction.
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Intensive care medicine · Apr 2010
Multicenter StudyAre small hospitals with small intensive care units able to treat patients with severe sepsis?
To find out whether mortality from sepsis is influenced by the size of the hospital and of the intensive care unit (ICU). ⋯ Treatment of surgical patients with severe sepsis in small ICUs was associated with increased mortality. Because of the relatively small sample size, further studies are needed to confirm or refute this association.
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Intensive care medicine · Apr 2010
GuidelineChapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.
To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on ensuring that adequate resources are available and appropriate protocols are developed to safely perform procedures in patients with and without influenza illness. ⋯ Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic.