Current opinion in critical care
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The population of chronically critically ill patients is growing as advances in intensive care management improve survival from the acute phase of critical illness. These patients are characterized by complex medical needs and heavy resource utilization. This article reviews evidence supporting a comprehensive approach to the prevention and management of chronic critical illness (CCI). ⋯ Combating CCI begins with prevention in the acute phase of illness. Management strategies include a spectrum of ventilatory, nutritional, and rehabilitation support. Further patient-centered outcome-based research in this specific population is needed to continue to help guide optimal care.
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Curr Opin Crit Care · Oct 2013
ReviewVentilator-associated events surveillance: a patient safety opportunity.
The Centers for Disease Control and Prevention recently released new surveillance definitions for ventilator-associated events. The new definitions broaden the focus of surveillance from ventilator-associated pneumonia alone to all significant complications of mechanical ventilation. This review will consider the rationale for the new definitions, the studies supporting their development, and their potential benefits for hospital safety programs. ⋯ Ventilator-associated event surveillance is a promising strategy to improve care for ventilated patients by providing hospitals with a broader picture of their true burden of morbid complications and an objective metric to measure the impact of care improvement initiatives. Prospective studies are now needed to define the best strategies to prevent ventilator-associated events and to quantify the extent to which they are preventable.
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Curr Opin Crit Care · Oct 2013
ReviewNew insights into the pathophysiology of cardiogenic shock: the role of the microcirculation.
The ultimate goal of therapy for cardiogenic shock is to restore microcirculatory function and thereby restore the oxygen supply to sustain cellular function. Therapeutic measures mainly focus on improving pressure-derived macrocirculatory parameters. However, it is increasingly clear that to achieve significant progress in treatment, microcirculatory physiopathological mechanisms must be considered. ⋯ Cardiogenic shock induces microcirculatory disorders that can be monitored and influenced in various manners, both pharmacologically and physically. In addition to global hemodynamic optimization, interventions must also ameliorate the microcirculation.
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Curr Opin Crit Care · Oct 2013
ReviewPrompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?
Failed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. ⋯ Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit.
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Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. ⋯ Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.