Current opinion in critical care
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Curr Opin Crit Care · Oct 2005
ReviewNew antibiotics for the treatment of severe staphylococcal infection in the critically ill patient.
Infection by Staphylococcus aureus in critically ill patients is usually associated with antimicrobial resistance and high mortality. A more effective antibiotic treatment is needed to replace older drugs that have limited efficacy. Novel substances active on methicillin-resistant Staphylococcus aureus, which are already available on the market or are still in development, are discussed in this review, with emphasis on nosocomial infections. ⋯ For the moment, there are limited and rather expensive therapeutic options for the infections by Staphylococcus aureus in the critically ill. No dramatic superiority of the new drugs in comparison to the standard therapies was observed in most of the clinical trials. Better results on the efficacy of the drugs under investigation are expected.
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Vasoactive drugs are the mainstay of hemodynamic management of vasodilatory shock when fluids fail to restore tissue perfusion. In this review, studies published during the past year that increase our understanding of the use of vasoactive drugs in the intensive care unit are discussed. ⋯ Over the last 40 years, there have been few controlled clinical trials to guide clinicians on the use of vasoactive drugs of treating shock states. It is not known whether the currently favored combination of norepinephrine and dobutamine is superior to traditional therapy with dopamine. Epinephrine is not recommended as the first-line therapy. The role of vasopressin and terlipressin remains unknown. Three large ongoing clinical trials will be completed soon and the results should clarify the role of these various agents.
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Measuring stroke volume or cardiac output is of paramount importance for the management of critically ill patients in the intensive care unit, or 'high risk' surgical patients in the operating room. The new noninvasive techniques are gaining acceptance among intensivists and anesthesiologists who have been trained almost exclusively in the pulmonary artery catheter and the thermodilution technique. ⋯ By making cardiac output easily measurable in various settings, these techniques should all contribute to improve hemodynamic management in critically ill or high-risk surgical patients.
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Curr Opin Crit Care · Oct 2005
ReviewTransfusion practice and nosocomial infection: assessing the evidence.
To evaluate recent literature describing the potential relation between transfusion practice in the intensive care unit and the subsequent risk for nosocomial infection. ⋯ Packed red blood cell transfusion may substantially increase the risk for nosocomial infection. The likely link between transfusion practice and nosocomial infection should factor into the provider's decision when determining when to transfuse.