Intensive care medicine
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Intensive care medicine · Jul 2012
ReviewAn overview of anthrax infection including the recently identified form of disease in injection drug users.
Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world. ⋯ Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax.
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Intensive care medicine · Jul 2012
Review Meta AnalysisSafety of gelatin for volume resuscitation--a systematic review and meta-analysis.
Gelatin is frequently used as a volume expander in critical care. Our goal was to investigate its safety. ⋯ Despite over 60 years of clinical practice, the safety and efficacy of gelatin cannot be reliably assessed in at least some settings in which it is currently used. We suggest the need to investigate and establish such safety.
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Intensive care medicine · Jul 2012
Review Meta AnalysisSafety of gelatin for volume resuscitation--a systematic review and meta-analysis.
Gelatin is frequently used as a volume expander in critical care. Our goal was to investigate its safety. ⋯ Despite over 60 years of clinical practice, the safety and efficacy of gelatin cannot be reliably assessed in at least some settings in which it is currently used. We suggest the need to investigate and establish such safety.
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Intensive care medicine · Jul 2012
ReviewInternational evidence-based recommendations on ultrasound-guided vascular access.
To provide clinicians with an evidence-based overview of all topics related to ultrasound vascular access. ⋯ These definitions and recommendations based on a critical evidence review and expert consensus are proposed to assist clinicians in ultrasound-guided vascular access and as a reference for future clinical research.