Intensive care medicine
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Intensive care medicine · Mar 2009
Influence of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance in critically ill medical patients.
To assess the role of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance. ⋯ In critically ill patients, quinolones and antipseudomonal cephalosporins may prevent the acquisition of P. aeruginosa and may have a negligible influence on the acquisition and emergence of resistance.
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Intensive care medicine · Mar 2009
Lithium dilution cardiac output measurement in the critically ill patient: determination of precision of the technique.
Lithium dilution cardiac output by LiDCOplus (LiDCO, Cambridge, UK) is a validated methodology for measuring cardiac output. It is used to calibrate a pulse pressure analysis algorithm (PulseCO) for the continuous measurement of subsequent changes in this variable. The variability of measurements, or precision, within patients of lithium dilution cardiac output has not previously been described. ⋯ To achieve a good precision with this technique, three lithium dilution measurements should be averaged. This will allow changes in cardiac output of more than 14% to be reliably detected. The understanding of the precision of this technique allows the user to know when a real change has happened to their patient.
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Intensive care medicine · Mar 2009
Continued survival gains in recent years among critically ill myeloma patients.
Therapeutic advances have improved survival in patients with myeloma (MM) over the past decade. We investigated whether survival has also improved in critically ill myeloma patients. ⋯ Hospital mortality decreased significantly over the last 15 years in myeloma patients admitted to the ICU. Risk factors for death were organ failure and poor chronic health status. Early ICU admission was associated with lower mortality, suggesting opportunities for further improving survival.
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Intensive care medicine · Mar 2009
Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough.
It remains uncertain why immunocompetent patients with bacterial community-acquired pneumonia (CAP) die, in spite of adequate antibiotics. ⋯ Mortality remains unacceptably high in immunocompetent patients admitted to the ICU with bacterial pneumonia, despite adequate initial antibiotics and comorbidities management. Patients with shock, acute renal failure and APACHE II score higher than 24 should be considered for inclusion in trials of adjunctive therapy in order to improve CAP survival.
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Intensive care medicine · Mar 2009
Transfusion practices for acute traumatic brain injury: a survey of physicians at US trauma centers.
To determine whether physician specialty influences transfusion threshold in patients with acute severe traumatic brain injury (TBI). ⋯ Neurosurgeons prefer more liberal transfusion of TBI patients than TS and CC, suggesting that actual practice may depend largely on which specialist is primarily managing care. The observed clinical equipoise would justify a randomized trial of liberal versus restrictive transfusion strategies in patients with TBI.