Intensive care medicine
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Intensive care medicine · May 2015
Review Meta AnalysisImpact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis.
To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors. ⋯ The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.
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Intensive care medicine · May 2015
Review Meta AnalysisImpact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis.
To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors. ⋯ The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.
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Intensive care medicine · May 2015
Review Meta Analysis Comparative StudyAssessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties.
To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery, and to evaluate, synthesise and compare the clinimetric properties of the measures identified. ⋯ There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness. Future work should identify a core set of standardized measures, which can be utilized across the continuum of critical illness recovery embedded within the International Classification of Functioning framework. This will enable improved comparisons between future studies, which in turn will assist in identifying the most effective treatment strategies to ameliorate the devastating longer-term outcomes of a critical illness.
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Intensive care medicine · May 2015
ReviewPreventive and therapeutic strategies in critically ill patients with highly resistant bacteria.
The antibiotic pipeline continues to diminish and the majority of the public remains unaware of this critical situation. The cause of the decline of antibiotic development is multifactorial and currently most ICUs are confronted with the challenge of multidrug-resistant organisms. Antimicrobial multidrug resistance is expanding all over the world, with extreme and pandrug resistance being increasingly encountered, especially in healthcare-associated infections in large highly specialized hospitals. ⋯ Inappropriate antimicrobial therapy, meaning the selection of an antibiotic to which the causative pathogen is resistant, is a consistent predictor of poor outcomes in septic patients. Therefore, pharmacokinetically/pharmacodynamically optimized dosing regimens should be given to all patients empirically and, once the pathogen and susceptibility are known, local stewardship practices may be employed on the basis of clinical response to redefine an appropriate regimen for the patient. This review will focus on the most severely ill patients, for whom substantial progress in organ support along with diagnostic and therapeutic strategies markedly increased the risk of nosocomial infections.