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
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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Cardiac troponins in serum have become the biomarkers of choice for the diagnosis of myocardial infarction. Yet, troponin can also be elevated by a multitude of causes in the absence of overt myocardial ischemia. Such nonspecific elevations are particularly common in the critically ill. This article aims to provide information on the significance of troponin elevations in unselected critically ill patients and in patients with sepsis or septic shock. ⋯ Troponin is frequently elevated in critically ill patients. More research is needed on the diagnostic and prognostic significance and possible clinical applications of troponin measurements in patients with sepsis and critical illness.
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Unilateral pulmonary edema (UPE) is an unusual manifestation of pulmonary edema that is frequently confused with other causes of unilateral alveolar and interstitial infiltrates. Until now limited data existed regarding the prevalence, cause, and outcome of patients presenting with cardiogenic UPE. The purpose of this review is to give insights into this rare entity. ⋯ UPE is not that rare as considered to be and is mostly related to severe organic or functional mitral regurgitation. Probably because of initial misdiagnosis and delayed appropriate treatment, UPE is related to increased mortality. History, absence of signs of infection, and elevated serum cardiac markers such as B-natriuretic peptide may help to differentiate UPE from other diagnoses. The key examination remains bedside transthoracic echocardiography, although transesophageal echocardiography can also provide additional information regarding the severity and mechanism of mitral regurgitation and documentation of the differential pressure between the right and left pulmonary veins.