Current opinion in critical care
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Curr Opin Crit Care · Oct 2007
ReviewPatient and caregiver counselling after the intensive care unit: what are the needs and how should they be met?
To examine current research on the psychological needs of both patients and their families following critical illness, and discuss how these may be met in a cost-effective manner. ⋯ Currently, there is an awareness of the psychological sequelae of critical illness for patients and their family caregivers, and with this a responsibility to assess and appropriately help those who are unable to manage their distress. The development and application of specialist psychological services after an episode of critical illness, possibly using a stepped care model, is in its infancy. There are a few centres of excellence that are currently employing these resources, but the vast majority of patients and their families are left to cope on their own. This lack of psychological support has important implications for long-term recovery and quality of life following the episode of critical illness.
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Curr Opin Crit Care · Oct 2007
ReviewBiomarkers to improve diagnostic and prognostic accuracy in systemic infections.
We review the advantages and drawbacks of biomarkers in the diagnostic and prognostic assessment of systemic infections. ⋯ If used in the proper setting, serial measurements of diagnostic biomarkers may allow treatments to be adjusted at an early stage in patients with severe infections. This may involve either intensifying treatment when infection levels stay high or avoiding unnecessary prolonged courses of antibiotics when levels rapidly decrease, thereby improving the allocation of healthcare resources.
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Curr Opin Crit Care · Oct 2007
ReviewThe role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of brain dysfunction.
Recent investigations demonstrate that most critical care survivors face significant brain-related morbidity including neurocognitive deficits. While current data on neurocognitive outcomes after critical illness are intriguing, gaps in the literature far exceed what we have learned to date. In this paper, we examine important areas of investigation heretofore unaddressed and propose directions for clinically oriented outcomes research. ⋯ Over the last decade, ICU-related cognitive impairment has been identified as a significant public health problem and has become the focus of intense investigation by researchers around the world. While substantial work has been done to date, vitally important questions remain. Future research should evaluate the mechanisms of and risk factors for brain injury, the natural history of neurocognitive dysfunction, structural and functional brain-imaging studies, and therapeutic modalities designed to prevent or decrease neuropsychological disability.
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Continuous infusion of beta-lactam antibiotics is becoming increasingly popular. The background and current clinical evidence are discussed. Tools to apply continuous infusion are analyzed. ⋯ Killing of bacteria by beta-lactam antibiotics is maximal at around four times the minimum inhibitory concentration in vitro. To ensure an optimal effect when treating severe infections, free unbound concentrations at or above four times the minimum inhibitory concentration should be maintained. Although continuous infusion has been demonstrated to be superior in animal studies, randomized clinical trials have failed to confirm this in humans, primarily because of suboptimal design. A better designed randomized clinical trial, set up as a pilot study, recently demonstrated a favorable outcome with continuous infusion. A major issue during continuous infusion is the stability of the antibiotic, which may limit its application. The calculation of the infusion rate necessary to obtain the desired free drug concentration is relatively straightforward.