Current opinion in critical care
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Curr Opin Crit Care · Oct 2007
ReviewPrompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock.
Treatment protocols targeting the rapid administration of appropriate antibiotics and hemodynamic support are now recognized as a key measure in the initial care of patients presenting with severe sepsis and septic shock. Strong evidence exists showing that time parameters, particularly in the emergency department, are as important as the nature of the treatment administered. The concept of sepsis bundles integrates evidence-based and time-sensitive issues, derived from international sepsis guidelines, to ensure that all eligible patients receive the right treatment as early as possible. ⋯ It seems logical that timely and protocolized treatment for patients presenting with severe sepsis and septic shock will impact on outcome. It remains to be shown, however, whether translating evidence into clinical practice will increase adherence to the bundles and positively impact on survival.
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Curr Opin Crit Care · Oct 2007
ReviewPercutaneous left ventricular assist devices for treatment of patients with cardiogenic shock.
This review will discuss the rationale and clinical utility of percutaneous left ventricular assist devices in the management of patients with cardiogenic shock. ⋯ The advent of percutaneous left ventricular assist devices constitutes an important advance in the management of patients with severe cardiogenic shock and may serve as bridge to recovery or heart transplantation in carefully selected patients. While improvement of hemodynamic parameters appears promising, it remains to be determined whether this benefit translates into improved clinical outcome.
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Curr Opin Crit Care · Oct 2007
ReviewInterventions to prevent transmission of antimicrobial-resistant bacteria in the intensive care unit.
Healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), and multidrug resistant Gram negative bacilli are a serious problem in ICUs. This review analyzes recent reports of interventions to prevent transmission of these organisms in the ICU. ⋯ Progress is being made in identifying interventions to prevent transmission of antimicrobial resistant bacteria in ICUs, although the strength of the evidence is limited compared with many therapeutic interventions. Large MRSA control initiatives launched during 2006 and 2007 may build on this work; their effects should be evaluated using proper study designs and analyses.
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The aim of this article is to review mechanisms of action of vasopressin and clinical studies of vasopressin in septic shock. ⋯ It is still unclear whether there is net benefit from low dose vasopressin infusion in patients who have septic shock. There may be certain patients who benefit but there are few studies of a prolonged vasopressin infusion to determine which patients benefit.