Surgical infections
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Anemia is a common complication of critical illness. Because tissue hypoxia is a prominent factor in the development of organ dysfunction in the critically ill, conventional wisdom has argued that the transfusion of packed red blood cells can attenuate tissue hypoxia and so improve outcome. ⋯ A conservative transfusion strategy appears safe in nearly all critically ill patients without active hemorrhage, including patients with cardiovascular disease. Whether a lower transfusion threshold could be adopted is unknown.
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Surgical infections · Jan 2005
ReviewHyperglycemia in the intensive care unit: no longer just a marker of illness severity.
Hyperglycemia is a common occurrence in critically ill patients. Recent evidence has demonstrated improved survival in patients in surgical intensive care units (SICUs) receiving "tight glycemic control." The mechanisms of this survival advantage are not well understood. ⋯ A number of human studies have demonstrated improved outcomes in critically ill patient populations receiving insulin therapy with a target of euglycemia, suggesting at least part of the benefit of this therapy is normal blood sugar and not the effects of insulin. An important population not studied to date is patients in the medical ICU. However, aggressive control of hyperglycemia now remains an important component of care for all surgical patients in the ICU.
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Surgical infections · Jan 2005
ReviewEmerging issues in the diagnosis and management of infections caused by multi-drug-resistant, gram-positive cocci.
Rising rates of multi-drug-resistant, gram-positive cocci (e.g., methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus spp. [VRE]) have created treatment challenges for clinicians in both the hospital and community settings. These organisms have become especially problematic for hospitalized patients with pneumonia, complicated intra-abdominal infections, and skin and skin-structure infections (SSSIs). ⋯ New antimicrobial agents are needed to combat the increasing prevalence of multi-drug-resistant, gram-positive pathogens such as MRSA. The emergence of resistance to available therapies such as vancomycin underscores this urgency.
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Surgical infections · Jan 2005
ReviewEmerging issues in the management of infections caused by multi-drug-resistant, gram-negative bacilli.
The past decade has witnessed the continued emergence and spread of multidrug resistance in gram-negative bacilli. Infections caused by multi-drug-resistant, gram-negative bacilli lead, in many instances, to increased morbidity and mortality, prolonged hospital stays, and the use of broad-spectrum antibiotics. ⋯ Tigecycline promises to be an important addition to our monotherapy armamentarium, complementing essential efforts to promote compliance with good infection control measures and rational use of currently available antimicrobial agents.
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Exposure of patients to allogeneic blood transfusion can be minimized or avoided by the systematic use of multiple blood conservation techniques. Current use of these technologies is variable. ⋯ Pharmacologic stimulation of erythropoiesis offers substantial potential to progress toward a goal of bloodless medicine. The potential of artificial blood substitutes is still being defined.