Current opinion in critical care
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Curr Opin Crit Care · Oct 2003
ReviewInflammatory biomarkers of the patient with myocardial insufficiency.
Inflammation plays a central role in the genesis of atherosclerosis and its complications. In this regard, plasma levels of several markers of inflammation have been shown to predict risk of future cardiovascular events, including cardiovascular death, myocardial infarction, and ischemic stroke. Furthermore, the predictive value of inflammatory markers is independent of traditional risk markers such as lipid levels, or cardiac troponin levels among those with acute coronary syndromes. ⋯ Combining our evolving understanding of the vascular biology of atherosclerosis with clinical studies of inflammatory markers and mediators may help refine our diagnostic and therapeutic armamentarium for cardiovascular disease.
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There is clear evidence that early and appropriate empiric antimicrobial therapy for suspected nosocomial infections reduces the rate of adverse outcomes. This approach necessitates a liberal antimicrobial policy, whereas observational and experimental data also suggest that excessive antibiotic use promotes the emergence of antimicrobial resistance, creating a dilemma for the intensivists and begging the question as to whether minimization of antimicrobial resistance and maximization of individual patient outcomes are mutually exclusive. ⋯ The focus is then on relative merits of routine antifungal prophylaxis as an example of an attempt to reduce the incidence and adverse consequences of late diagnoses of fungal sepsis. Finally, the advantages and disadvantages of antimicrobial cycling as a means of reducing antimicrobial resistance in the intensive care unit are outlined.
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Curr Opin Crit Care · Aug 2003
ReviewIs the implementation of research findings in the critically ill hampered by the lack of universal definitions of illness?
In the design of clinical trials, a clear definition of disease is essential for enrollment of a homogeneous study population with a higher likelihood of demonstrating a benefit of an intervention. A definition that is applicable to standard clinical practice enhances the ability of clinicians to apply results of the clinical trial to patient care. Use of a universally accepted definition allows valid comparisons across multiple studies. ⋯ When investigators and clinicians do not adhere to common definitions of disease, results of clinical trials may be applied inappropriately or ignored altogether. More specific identifiers of critical illnesses using specific biochemical or genetic markers are being explored. This approach may also be useful for staging disease.
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Curr Opin Crit Care · Aug 2003
ReviewControversy of immunonutrition for surgical critical-illness patients.
Specific nutrients such as arginine, glutamine, dietary nucleotides, and omega-3 fatty acids have been shown to influence infectious morbidity, antibiotic use, and hospital length of stay. The combination of these nutrients into one enteral formulation has become known as immune-enhancing diets. Consensus guidelines developed by a number of clinical investigators and published in 2001 concluded that immune-enhancing diets were beneficial in moderate to severely malnourished patients undergoing elective gastrointestinal surgery and patients sustaining severe blunt and penetrating torso trauma. ⋯ Results confirmed the benefits of preoperative administration of immune-enhancing diets in surgical patients but also demonstrated that postoperative administration offered no advantages. Decreased infectious complications were also observed in critically ill patients receiving immune-enhancing diets. Accumulating evidence supports the use of immune-enhancing diets in these specific patient populations.