Current opinion in critical care
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Curr Opin Crit Care · Oct 2003
ReviewImplantable cardioverter-defibrillators in cardiovascular care: technologic advances and new indications.
Present generation implantable cardioverter-defibrillators (ICD) have become a proven primary therapeutic option in management of symptomatic ventricular arrhythmias and are now being increasingly used for primary prevention. The addition of biventricular pacing and atrial defibrillation to these devices has had an impact on the management of several new patient populations. The widespread application of these devices requires precise knowledge of their potential benefits and factors that could adversely affect device function. ⋯ Implantable cardioverter defibrillators have proven to be invaluable in the primary and secondary prevention of sudden cardiac death. Incorporation of new technology in these devices has resulted in expanded indications that improve survival and quality of life of new patient populations.
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Curr Opin Crit Care · Oct 2003
ReviewAntimicrobial resistance among gram-positive organisms in the intensive care unit.
The epidemiology of gram-positive pathogens in the intensive care unit are reviewed, recent trends in antimicrobial resistance among these organisms are discussed, and the significance of these data with respect to treatment are considered. ⋯ An awareness of the prevalence and patterns of resistance among gram-positive nosocomial pathogens is vital for the appropriate treatment of hospitalized patients. In addition, efforts must be made to minimize the selection and spread of these organisms.
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Curr Opin Crit Care · Oct 2003
ReviewIntraabdominal sepsis: newer interventional and antimicrobial therapies for infected necrotizing pancreatitis.
Recent advances in interventional techniques and antimicrobial therapy have significantly affected the morbidity and mortality of infected pancreatic necrosis. This review describes elements of this progress. ⋯ These findings recommend the practice of routine antibacterial prophylaxis with systemic agents. Patients receiving such treatment should be monitored for colonization by yeast; surveillance cultures do not appear to be necessary because these critically ill patients have an inflammatory disease and frequently experience temperature elevations warranting cultures to rule out infection. If infection is documented by aspiration or intervention, aggressive antimicrobial therapy directed at organisms identified by Gram stain should be started. Classes of antimicrobial agents other than those used for prophylaxis should be used.
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This review examines the various techniques used to diagnose ventilator-associated pneumonia. The ideal diagnostic test not only helps the clinician to recognize whether pneumonia is present, but also to influence clinical outcome. ⋯ Diagnostic testing for ventilator-associated pneumonia can identify those patients at risk for a poor clinical outcome.