Current opinion in critical care
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Curr Opin Crit Care · Oct 2013
ReviewContinuous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients: where is the evidence?
Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (Pcuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of Pcuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP. ⋯ Continuous controllers of Pcuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of Pcuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.
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Curr Opin Crit Care · Oct 2013
ReviewAssessing the impact of palliative care in the intensive care unit through the lens of patient-centered outcomes research.
Professional organizations, consensus groups, and stakeholders are calling for better palliative care in acute care settings, particularly in ICUs. Our ability to deliver that care is dependent on the outcomes associated with palliative care in the ICU. This review provides a conceptual framework for these outcomes, discusses current and future challenges for work in this field, and advocates for better use of patient-centered outcomes in future studies. ⋯ Delivery of palliative care in the ICU will be hampered until studies incorporate outcomes that are: responsive to and reflective of variations in care, and multi-faceted (with patient-centered components) to reflect the multi-dimensional nature of palliative care and the varied needs of different stakeholders.
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Despite developments in treatment of myocardial infarction, mortality rates in cardiogenic shock remain unacceptably high. Intra-aortic balloon pumping (IABP) is to date the most used device for hemodynamic support, but randomized evidence on survival benefit was lacking. ⋯ In cardiogenic shock, no general recommendation for IABP can be given. In the next revision of current guidelines, recent randomized trial results should be incorporated. Further research is needed to develop optional treatments in cardiogenic shock or to gain validated algorithms for use of active assist devices.
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Curr Opin Crit Care · Oct 2013
ReviewUsing procalcitonin-guided algorithms to improve antimicrobial therapy in ICU patients with respiratory infections and sepsis.
In patients with systemic bacterial infections hospitalized in ICUs, the inflammatory biomarker procalcitonin (PCT) has been shown to aid diagnosis, antibiotic stewardship, and risk stratification. Our aim is to summarize recent evidence about the utility of PCT in the critical care setting and discuss the potential benefits and limitations of PCT when used for clinical decision-making. ⋯ Inclusion of PCT data in clinical algorithms improves individualized decision-making regarding antibiotic treatment in patients in critical care for respiratory infections or sepsis. Future research should focus on use of repeated PCT measurements to risk-stratify patients and guide treatment to improve their outcomes.