Critical care clinics
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Critical care clinics · Oct 2013
ReviewPrevention, Diagnosis, and Management of Surgical Site Infections: Relevant Considerations for Critical Care Medicine.
Surgical site infection complicates 2% to 5% of all operative procedures. Many of the risk factors for the development of a surgical site infection (eg, old age, major comorbidity, emergency surgery) are present in patients typically requiring postoperative admission to the intensive care unit. This article reviews the risk factors and measures to prevent surgical site infection and diagnostic and management considerations relevant to critical care medicine.
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Critical care clinics · Oct 2013
ReviewOther Viral Pneumonias: Coronavirus, Respiratory Syncytial Virus, Adenovirus, Hantavirus.
Severe viral pneumonia is an increasing problem among adults. The incidence and number of viruses known to cause pneumonia and respiratory failure have also expanded in recent years. ⋯ Management of individual cases is mainly supportive and requires institution of appropriate infection control measures. Vaccines and effective therapeutics for these potentially devastating respiratory viruses are urgently required.
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Clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus that can produce severe colitis resulting in death. There has been an overall increase in the incidence of Clostridium difficile-associated disease and, particularly, an increase in the more virulent forms of the disease. Treatment of severe C difficile infection includes management of severe sepsis and shock, pathogen-directed antibiotic therapy, and, in selected cases, surgical intervention. Ultimately, prevention is the key to limiting the devastating effects of this microorganism.
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Infective endocarditis has many facets and various expressions depending on the site of infection, microorganism, underlying heart lesion, immune status of the host, and remote effects such as emboli, organ dysfunction, and the condition of the host. Diagnosis depends on meticulous clinical examination, blood cultures results, and echocardiographic findings. The management of the patient with endocarditis in the intensive care unit is complex and needs a multidisciplinary team, including an intensivist, cardiologist, experienced echocardiologist, infectious diseases specialist, and cardiac surgeon. The medical and surgical management of such patients is complex, and timely decisions are important.
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Necrotizing soft tissue infections (NSTIs) are infrequent yet highly lethal infections, and a high index of suspicion is required for early diagnosis. Diagnosing NSTIs early can be challenging, and knowledge of the available tools is essential to provide appropriate treatment. ⋯ Mortality continues to be high, and delayed surgical treatment is the most important risk factor. For the long-term recovery of patients with NSTI, providing early physiologic and nutritional support and physical rehabilitation is essential.