Articles: sepsis.
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Critical care clinics · Oct 2023
ReviewMaking the Improbable Possible: Generalizing Models Designed for a Syndrome-Based, Heterogeneous Patient Landscape.
Syndromic conditions, such as sepsis, are commonly encountered in the intensive care unit. Although these conditions are easy for clinicians to grasp, these conditions may limit the performance of machine-learning algorithms. ⋯ Recent advances in data science, such as transfer learning, conformal prediction, and continual learning, may improve generalizability of machine-learning algorithms in critically ill patients. Randomized trials with these approaches are indicated to demonstrate improvements in patient-centered outcomes at this point.
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Curr Opin Crit Care · Oct 2023
ReviewHealth system approaches to providing posthospital care for survivors of sepsis and critical illness.
In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. ⋯ Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.
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Curr Opin Crit Care · Oct 2023
ReviewInvasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile.
In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades. ⋯ The classic risk profile ('host factors') reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.
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Journal of critical care · Oct 2023
ReviewAntimicrobial resistance and outcome in the critically ill patient: An opinion paper.
Antimicrobial resistance (AMR) is associated with increased mortality and resources consumption in critically ill patients. However, the causality of AMR in this mortality remains unclear. This opinion paper aims to overview the effects of multidrug resistant (MDR) pathogens on the outcomes of critically ill patients, considering different variables as appropriateness of empirical antimicrobial therapy, severity of sepsis, comorbid conditions and frailty. ⋯ However, the patients carrying MDR pathogens, as compared with those carrying non-MDR pathogens, are those with co-morbid conditions, high risk of frailty and invasive procedures. In addition, inappropriate empirical antibiotics are more often used in these patients as well as withholding and withdrawing of life-sustained therapy. Future studies on AMR should report the rate of appropriateness of empirical antimicrobial therapy, withholding and withdrawing of life-sustained therapy.
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Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU. ⋯ Primary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.