Critical care clinics
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Critical care clinics · Jul 2013
ReviewToxic shock syndrome: major advances in pathogenesis, but not treatment.
Toxic shock syndrome (TSS) is primarily the result of a superantigen-mediated cytokine storm and M protein-mediated neutrophil activation, resulting in the release of mediators leading to respiratory failure, vascular leakage, and shock. Mortality for streptococcal TSS still hovers at 50%. There is evidence to support a role for intravenous immunoglobulin (IVIG) in the treatment of streptococcal TSS. An observational study suggests that an initial conservative surgical approach combined with the use of immune modulators, such as IVIG, may reduce the morbidity associated with extensive surgical exploration in hemodynamically unstable patients without increasing mortality.
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Acute liver failure (ALF) is a condition wherein the previously healthy liver rapidly deteriorates, resulting in jaundice, encephalopathy, and coagulopathy. There are approximately 2000 cases per year of ALF in the United States. ⋯ Given the ease of spread of viral hepatitis and the high morbidity and mortality associated with ALF, a systematic approach to the diagnosis and treatment of FVH is required. In this review, the authors describe the viral causes of ALF and review the intensive care unit management of patients with FVH.
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Infections have plagued humans since the beginning of recorded history. Huge segments of the human population were episodically wiped out by epidemic infectious diseases in past centuries. ⋯ Much of this work has involved the elderly because that group is uniquely predisposed to morbidity and mortality from infection. It is hoped that continued research will result in a decrease in infection morbidity and mortality in elderly.
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The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.
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Nosocomial pneumonia remains a significant cause of hospital-acquired infection, imposing substantial economic burden on the health care system worldwide. Various preventive strategies have been increasingly used to prevent the development of pneumonia. It is now recognized that patients with health care-associated pneumonia are a heterogeneous population and that not all are at risk for infection with nosocomial pneumonia pathogens, with some being infected with the same organisms as in community-acquired pneumonia. This review discusses the risk factors for nosocomial pneumonia, controversies in its diagnosis, and approaches to the treatment and prevention of nosocomial and health care-associated pneumonia.