Current opinion in critical care
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Curr Opin Crit Care · Oct 2011
ReviewPerioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients.
Cardiac complications after noncardiac surgery cause significant morbidity and mortality. This review will discuss recent developments in risk stratification, monitoring, and risk reduction strategies. ⋯ Systematic preoperative assessment can identify patients at high risk of cardiac complications and guide the application of appropriate risk reduction strategies.
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Curr Opin Crit Care · Oct 2011
ReviewCurrent insights in sepsis: from pathogenesis to new treatment targets.
Sepsis continues to be a leading cause of ICU death. This review summarizes current knowledge on sepsis pathogenesis and new therapeutical strategies. ⋯ Sepsis can be seen as a PRR-mediated dysregulation of the immune system following pathogen invasion in which a careful balance between inflammatory and anti-inflammatory responses is vital. Detailed knowledge of host response pathways and new approaches in sepsis trial design, which take into account patient heterogeneity and the phase of the immunological response, represent major steps forward in sepsis research.
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Curr Opin Crit Care · Oct 2011
ReviewHealth-related quality of life: implications for critical care interventional studies and why we need to collaborate with patients.
Health-related quality of life (HRQoL) is an important patient-reported outcome measure following critical illness. 'Validated' and professionally endorsed generic measures are widely used to evaluate critical care intervention and guide practice, policy and research. Although recognizing that they are 'here to stay', leading QoL researchers are beginning to question their 'fitness for purpose'. It is therefore timely to review critiques of their limitations in the wider healthcare and social science literatures and to examine the implications for critical care research including, in particular, emerging interventional studies in which HRQoL is the primary outcome of interest. ⋯ Collaboration with patients is advocated in order to improve the interpretation and utility of such data. Failure to do so may result in important study effects being overlooked and the dismissal of potentially useful interventions.
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Curr Opin Crit Care · Oct 2011
ReviewTrends in antimicrobial resistance in intensive care units in the United States.
Antimicrobial resistance and a paucity of new antimicrobial agents are ongoing challenges. This review focuses on the major epidemiologic trends and novel treatments, when available, for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, Clostridium difficile, and multidrug-resistant Gram-negative bacilli in the United States during 2010-2011. ⋯ Antimicrobial resistance, particularly among Gram-negative bacilli, continues to increase at a rapid rate. Given the frequent transfer of patients between outpatient and acute care settings, as well as between different geographic regions, coordinated infection control interventions are warranted.
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Curr Opin Crit Care · Oct 2011
ReviewMechanical assistance of the circulation during cardiogenic shock.
Cardiogenic shock still has a grave prognosis. We present the recent advances in mechanical circulatory support (MCS) for the treatment of refractory cardiogenic shock. ⋯ Although MCS can be life saving in cardiogenic shock, the results are still suboptimal. Mortality is associated with the critical presupport state and the adverse events during MCS. Early initiation of support that meets the patient's requirements, potent support in the early phase, adverse event prevention, global combined management (surgical, interventional, medical), balanced support duration, bridging to further therapeutic modalities including heart transplantation or longer-term support, and advanced technology could offer improved results.