Current opinion in critical care
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We aim to help clinicians to use and interpret high-sensitivity cardiac troponins (cTns) in different acute care settings. This guidance is timely and relevant as high-sensitivity cTns are currently replacing conventional cTn assays in most parts of the world. ⋯ In all of these, elevated levels of high-sensitivity cTn are associated with increased mortality risk. In some of these, concepts are evolving as to how the pathophysiological signal of cardiomyocyte injury could be used to alter patient management and potentially improve outcomes.
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Curr Opin Crit Care · Oct 2014
ReviewAntibiotic treatment of ventilator-associated tracheobronchitis: to treat or not to treat?
To evaluate the data on antimicrobial therapy for ventilator-associated tracheobronchitis (VAT) to prevent ventilator-associated pneumonia (VAP), and its impact on patient outcomes. ⋯ This review focuses on diagnostic criteria for VAT and VAP, etiologic agents, rationale and benefits of initiating pre-emptive, appropriate antibiotic treatment for VAT to prevent VAP, improve patient outcomes and associated acute and chronic healthcare costs.
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Curr Opin Crit Care · Oct 2014
ReviewChronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia.
To discuss recent data on the relationship between chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP). ⋯ COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.
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Curr Opin Crit Care · Oct 2014
ReviewInfection control measures to decrease the burden of antimicrobial resistance in the critical care setting.
The prevalence of multidrug-resistant organisms (MDROs) in ICUs is increasing worldwide. This review assesses the role of infection control measures, excluding antibiotic stewardship programs, in reducing the burden of resistance in ICUs. ⋯ In the recent years, several high-quality clinical studies have assessed the ability of various infection control measures in reducing the burden of antimicrobial resistance. Significant progress has been made in identifying interventions effective in preventing transmission of MDROs in ICUs, in particular, decolonization. However, it still remains impossible to determine the exact and relative importance of different infection control measures. Any approach must ultimately be tailored to the local epidemiology of the targeted ICU.
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Curr Opin Crit Care · Oct 2014
ReviewOptimal data systems: the future of clinical predictions and decision support.
The purpose of the review is to describe the evolving concept and role of data as it relates to clinical predictions and decision-making. ⋯ Modern electronic medical records create an opportunity to design complete and functional data systems that can support clinical care to a degree never seen before. Such systems are often referred to as 'data-driven,' but a better term is 'optimal data systems' (ODS). Here we discuss basic features of an ODS and its benefits, including the potential to transform clinical prediction and decision support.