Current opinion in critical care
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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
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
ReviewEvidence-based infection control in the ICU (except catheters).
To evaluate the recent literature on new randomized controlled trials and metaanalyses investigating infection control measures in the ICU. The focus is on ventilator-associated pneumonia, urinary tract infections and surgical site infections. ⋯ There is currently enormous interest in the field of infection control in ICU patients. Experts in this field are aiming to summarize existing knowledge on decreasing nosocomial infection rates and to update guidelines. Translating infection prevention evidence into practice, however, is also a very import element of ICU infection control and should be the main focus of further studies.
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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.
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Curr Opin Crit Care · Oct 2007
ReviewInterventions to improve long-term outcomes after critical illness.
The aim of this article is to review the literature specifically on interventions that are targeted at improving health related quality of life in survivors of critical illness. Although there is a growing literature describing the impairment in quality of life of survivors of critical illness, there are a considerably smaller number of studies describing effective interventions at treating or preventing these complications. The topic is complex because critical illness spans a number of diseases including spinal cord injury and myocardial infarction that have an extensive rehabilitation literature. ⋯ Research interest in developing interventions to improve long-term outcome after critical illness is in its infancy and it is too early to make strong clinical recommendations. Multiple potential treatment areas exist both within the ICU and after patients leave the hospital for intensivists to target.