Annals of intensive care
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Depression of left ventricular (LV) intrinsic contractility is constant in patients with septic shock. Because most parameters of cardiac function are strongly dependent on afterload, especially in this context, the cardiac performance evaluated at the bedside reflects intrinsic contractility, but also the degree of vasoplegia. Recent advances in echocardiography have allowed better characterization of septic cardiomyopathy. ⋯ Unlike classic cardiomyopathy, it is not associated with high filling pressures, for two reasons: improvement in LV compliance and associated right ventricular dysfunction. Although, it is unclear to which extent it affects prognosis, a hyperkinetic state is indicative of a profound and persistent vasoplegia associated with a high mortality rate. Preliminary data suggest that the hemodynamic response to a dobutamine challenge has a prognostic value, but large studies are required to establish whether inotropic drugs should be used to treat this septic cardiac dysfunction.
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Annals of intensive care · Jan 2011
New materials and devices for preventing catheter-related infections.
Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. ⋯ Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies.
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Annals of intensive care · Jan 2011
Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review.
Noninvasive positive pressure ventilation (NPPV) refers to the delivery of mechanical respiratory support without the use of endotracheal intubation (ETI). The present review focused on the effectiveness of NPPV in children > 1 month of age with acute respiratory failure (ARF) due to different conditions. ARF is the most common cause of cardiac arrest in children. ⋯ High FiO2 needs or high PaCO2 level on admission or within the first hours after starting NPPV appeared to be the best independent predictive factors for the NPPV failure in children with ARF. However, many important issues, such as the identification of the patient, the right time for NPPV application, and the appropriate setting, are still lacking. Further randomized, controlled trials that address these issues in children with ARF are recommended.
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Annals of intensive care · Jan 2011
Community-acquired necrotizing pneumonia due to methicillin-sensitive Staphylococcus aureus secreting Panton-Valentine leukocidin: a review of case reports.
Community-acquired necrotizing pneumonia caused by Panton-Valentine leukocidin (PVL)-secreting Staphylococcus aureus is a highly lethal infection that mainly affects healthy children and young adults. Both methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) may carry the PVL-phage, but the majority of publications relate to community-associated methicillin-resistant S. aureus (CA-MRSA) or mixed patient groups. This study focuses on necrotizing pneumonia due to methicillin-sensitive S. aureus strains, with the purpose to determine factors associated with outcome. ⋯ Influenza-like prodrome may be predictive of adverse outcome in PVL-secreting MSSA necrotizing pneumonia. In contrast, previous skin and soft-tissue infection may be associated with improved prognosis.
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Annals of intensive care · Jan 2011
Ventilator-induced lung injury: historical perspectives and clinical implications.
Mechanical ventilation can produce lung physiological and morphological alterations termed ventilator-induced lung injury (VILI). Early experimental studies demonstrated that the main determinant of VILI is lung end-inspiratory volume. ⋯ The significance of inflammatory alterations observed during VILI is debated and has not translated into clinical application. This review examines seminal experimental studies that led to our current understanding of VILI and contributed to the current recommendations in the respiratory support of ARDS patients.