Critical care medicine
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Critical care medicine · Jan 2012
Prevention of ventilator-associated pneumonia or ventilator-associated complications: a worthy, yet challenging, goal.
Ventilator-associated pneumonia is a difficult diagnosis to establish in the critically ill patient because of the presence of underlying cardiopulmonary disorders (e.g., pulmonary contusion, acute respiratory distress syndrome, atelectasis) and the nonspecific radiographic and clinical signs associated with this infection. However, the escalating antimicrobial resistance of the bacterial pathogens associated with ventilator-associated pneumonia, as well as with other nosocomial infections, has created an imperative to reduce their occurrence and the unnecessary use of antibiotics. ⋯ Given current restrictions in hospital resources, absence of available new antimicrobial agents, and potential lack of reimbursement for patients with development of ventilator-associated pneumonia, hospitals need to develop and successfully implement programs aimed at reducing ventilator-associated pneumonia. The use of evidence-based bundles targeting ventilator-associated pneumonia seems to be a reasonable first step in addressing this important clinical problem.
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Critical care medicine · Jan 2012
Comparative StudyEfficacy of linezolid compared to vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus in ventilated pigs.
To assess the efficacy of linezolid compared with vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus (MRSA) in ventilated pigs. ⋯ In this animal model of MRSA pneumonia, linezolid showed a better efficacy than vancomycin showed because of a better pharmacokinetics/pharmacodynamics index.
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Critical care medicine · Jan 2012
Case ReportsCoronary stent thrombosis in patients undergoing multidigit replantation.
The development of drug-eluting stents has decreased the rate of in-stent restenosis. However, there have been reports of late stent thrombosis in patients with drug-eluting stents, especially when dual antiplatelet therapy is interrupted. The high mortality rate associated with cardiac stent thrombosis has led to recent recommendations regarding duration of antiplatelet therapy as well as timing of elective surgery in patients with both drug-eluting stents and bare metal stents. However, in patients requiring emergency operations, delaying surgery is not an option. ⋯ Several factors including large transfusion requirements and the complex pharmacogenetics of clopidogrel may have played a role. These cases bring to light the increasing number of patients with indwelling drug-eluting stents in whom the need for massive surgical or trauma type management will become more frequent.