Current opinion in critical care
-
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.
-
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.
-
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.
-
Curr Opin Crit Care · Oct 2005
ReviewNutrition and infection in the intensive care unit: what does the evidence show?
Nutrition support when applied appropriately, can improve clinical outcomes, particularly the incidence of infections. The Canadian Clinical Practice Guidelines for Nutrition Support, published in October 2003, summarized the evidence on nutrition support in the critically ill patient and provided recommendations aimed at maximizing the benefits of nutrition support while minimizing the risks. The purpose of this review is to highlight recent advances in nutrition research in critically ill adult patients, particularly with respect to minimizing infection. The newly published data will be used to update the Canadian Clinical Practice Guidelines. ⋯ This review provides insights into the results of recent randomized trials on nutrition support in critically ill patients. The Canadian Clinical Practice Guidelines for nutrition support help intensive care unit clinicians to keep abreast of emerging evidence and the impact of nutrition support practices on outcomes such as infections.