Intensive care medicine
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Intensive care medicine · Jan 2014
De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock.
We set out to assess the safety and the impact on in-hospital and 90-day mortality of antibiotic de-escalation in patients admitted to the ICU with severe sepsis or septic shock. ⋯ De-escalation therapy for severe sepsis and septic shock is a safe strategy associated with a lower mortality. Efforts to increase the frequency of this strategy are fully justified.
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Intensive care medicine · Jan 2014
De-escalation of antimicrobial treatment in neutropenic patients with severe sepsis: results from an observational study.
In severe sepsis, guidelines recommend de-escalating the empirical antimicrobial treatment as soon as the microbiological results are available. We aimed to determine the rate of de-escalation of the empirical antimicrobial treatment in neutropenic patients with severe sepsis. The characteristics of antimicrobial treatment associated with de-escalation and its impact on short- and long-term survival were also determined. ⋯ Our data suggest that, in ICU, de-escalation of the empirical antimicrobial treatment is frequently applied in neutropenic cancer patients with severe sepsis. No evidence of any prognostic impact of this de-escalation was found.
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Intensive care medicine · Jan 2014
Impact of lung ultrasound on clinical decision making in critically ill patients.
To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients. ⋯ Our study shows that LU has a significant impact on decision making and therapeutic management.
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Intensive care medicine · Jan 2014
ReviewUnrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients.
Intensive care unit (ICU) patients are exposed to many sources of discomfort. Although increasing attention is being given to the detection and treatment of pain, very little is given to the detection and treatment of dyspnea (defined as "breathing discomfort"). ⋯ Future studies are needed to better delineate the impact of dyspnea in the ICU and to define diagnostic, monitoring and therapeutic protocols.