Current opinion in critical care
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This review describes recent findings related to molecular-based methods of potential application in the diagnosis of bacterial hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP). It focuses on methods capable of providing organism identification and keys of bacterial resistance necessary in clinical and epidemiological management of patients and on their ability to provide quantitative results. ⋯ Despite some limitations, current molecular diagnostic methods have a great potential to include bacterial targets useful in the identification of microorganisms and antimicrobial resistance, to analyze directly unprocessed samples and to obtain quantitative results in bacterial HAP/VAP, an entity of complex microbiological diagnosis due to the features of the pathogens commonly implicated.
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To identify the recent literature supporting the ability of anesthesiologists to impact morbidity and mortality outside of the immediate intraoperative period. ⋯ Anesthesiologists should consider implication of goal-directed therapy in high-risk surgical patients, adhere to the American College of Cardiology/American Heart Association guidelines with regard to perioperative β-blockade, critically assess the data to support their choice of synthetic colloids over crystalloids, explore all possible strategies for avoiding perioperative transfusion, and be cognizant of their potential contribution to perioperative infectious morbidity.
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Curr Opin Crit Care · Aug 2012
ReviewImportance of intravenous fluid dose and composition in surgical ICU patients.
This review discusses the importance of intravenous fluid dose and composition in surgical ICU patients. On the basis of updated physiologic postulates, we suggest guidelines for the use of crystalloids and colloids. Goal-directed fluid therapy is advocated as a means for avoiding both hypovolemia and hypervolemia. ⋯ The routine replacement of unmeasured presumed fluid deficits is not appropriate. In critically ill patients, resuscitation with intravenous fluids should produce a demonstrable enhancement of perfusion. Individualized goal-directed therapy using functional hemodynamic parameters can optimize resuscitation and 'deresuscitation'.