Current opinion in critical care
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Curr Opin Crit Care · Oct 2013
ReviewSelected insights from application of whole-genome sequencing for outbreak investigations.
The advent of high-throughput whole-genome sequencing has the potential to revolutionize the conduct of outbreak investigation. Because of its ultimate resolution power for differentiating between closely related pathogen strains, whole-genome sequencing could augment the traditional epidemiologic investigations of infectious disease outbreaks. ⋯ When combined with traditional epidemiologic investigation, whole-genome sequencing has proven useful for elucidating the sources and transmission dynamics of disease outbreaks. Development of a fully automated bioinformatics pipeline for the analysis of whole-genome sequence data is much needed to make this powerful tool more widely accessible.
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Although it has been demonstrated that physical functional impairments are common among survivors of critical illness, few studies have proven benefits of intervention. This review will discuss assessment of physical functional impairment, recent and ongoing interventional studies, and implementation of rehabilitation beginning in the ICU, hospital ward, and after hospital discharge. ⋯ Improving physical function for survivors of critical illness will require careful application of current knowledge, as well as rigorous investigation into causes, research methodologies, and implementation of results of future interventional studies.
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Curr Opin Crit Care · Oct 2013
ReviewConservative initiation of antimicrobial treatment in ICU patients with suspected ICU-acquired infection: more haste less speed.
To review the recent literature supporting the idea that in some patients suspected of having a new ICU-acquired infection, antibiotics can be withheld until evidence to confirm diagnosis is obtained. ⋯ In the ICU, patients without septic shock but suspected of having an ICU-acquired infection may be able to have antibiotics withheld until infection is confirmed using a combination of laboratory, radiologic, and microbiological data.
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Curr Opin Crit Care · Oct 2013
ReviewNovelties in biomarkers for the management of circulatory failure.
The purpose of the present work was to review the literature on the role of biomarkers for the diagnosis, the risk stratification, and the management of circulatory failure. ⋯ Because of the tight association between circulatory and renal failure, we put a special emphasis on cardiovascular [B-type natriuretic peptide (BNP), Nt-proBNP, troponin, QSOX-1, sST-2, mid-regional pro-atrial natriuretic peptide] and renal biomarkers (neutrophil gelatinase-associated lipocalin, cystatin C, liver-type fatty acid-binding protein, kidney injury molecule-1, insulin-like growth factor-binding protein-7, tissue inhibitor of metalloproteinase-2). We also discuss nonspecific biomarkers (pro-ADM, glycemia, MicroRNA, chromogramin A) in this setting. We discuss the potential interest and limits, from diagnosis to prognosis reclassification, of cutting-edge new biomarkers, but also widely available and inexpensive biomarkers, in the particular setting of circulatory failure.
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Curr Opin Crit Care · Oct 2013
ReviewEvaluation of left ventricular structure and function by three-dimensional echocardiography.
To summarize research on the use of 3-dimensional (3D) echocardiography for quantifying left ventricular (LV) volumes, ejection fraction, and mass, and to describe emerging applications of the technology. ⋯ With real-time 3DTTE, one can acquire and display a 3D image encompassing the entire LV within seconds. Because 3DTTE aids in identification of the true LV apex, it provides more accurate LV volumes than its 2D counterpart. As compared with a cardiovascular magnetic resonance standard, 3DTTE tends to slightly underestimate LV volumes, in part because its spatial resolution is limited, making identification of the true endocardial border more difficult. As compared with 2DTTE, 3DTTE is advantageous for identifying and assessing the extent of regional wall motion abnormalities. For quantification of LV mass, 3DTTE is superior to both 2DTTE and M-mode echocardiography. Emerging applications of 3DTTE include speckle-tracking strain assessment, dyssynchrony analysis, and LV shape analysis, which appear to have prognostic value in patients with a variety of cardiac conditions.