Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Feb 2015
Observational StudyInvasive Candida infections in patients of a medical intensive care unit: attempt of improving diagnosis by quantifying the colonization.
During the past decades, a steady increase in the incidence of invasive Candida infections in patients requiring intensive care has been reported. Nevertheless, the diagnosis of invasive Candida infections in the intensive care unit setting remains still difficult and is often made late in the course of disease. Additionally, prognosis worsens rapidly with delayed initiation of antifungal therapy. Clinical scoring systems such as the Candida colonization index or the four risk factor-based Candida score could be very useful tools to select patients at high risk of developing invasive Candida infections, who would benefit from the administration of systemic antifungal therapy. ⋯ Both the Candida colonization index and the Candida score with cut-off values ≥ 0.5 and ≥ 2.5 are very useful tools to select patients at high risk of developing invasive Candida infections in the medical intensive care unit setting, who would benefit from early antifungal treatment.
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Wien. Klin. Wochenschr. · Feb 2015
The possible impact of the German DRGs reimbursement system on end-of-life decision making in a surgical intensive care unit.
More than 70 % of critically ill patients die in intensive care units (ICUs) after treatment is reduced. End-of-life decision making in the ICU is a grey area that varies in practice, and there are potential economic consequences of over- and under-treatment. The aim of this study was to describe the end-of-life decisions of critically ill patients in a surgical ICU in Germany and to identify how financial incentives may influence decision making. ⋯ There are still few patients with clear self-determination, and almost half of therapies are performed only according to presumed consent. The strong nonlinear dependence of DRG revenues on ventilation hours could influence ethical decision making of medical professionals. The decision-making process and appropriate therapy in the ICU setting need to be defined more clearly and better documented, focusing on the benefits to the patient while respecting patient consent.
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Wien. Klin. Wochenschr. · Feb 2015
Letter Case Reports Comparative StudyIncomplete (135°) prone position as an alternative to full prone position for lung recruitment in ARDS during ECMO therapy.