Intensive care medicine
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Intensive care medicine · Jul 2015
Practice GuidelineStrategies to reduce curative antibiotic therapy in intensive care units (adult and paediatric).
Emerging resistance to antibiotics shows no signs of decline. At the same time, few new antibacterials are being discovered. There is a worldwide recognition regarding the danger of this situation. ⋯ Five fields were explored: i) the link between the resistance of bacteria and the use of antibiotics in intensive care; ii) which microbiological data and how to use them to reduce antibiotic consumption; iii) how should antibiotic therapy be chosen to limit consumption of antibiotics; iv) how can antibiotic administration be optimized; v) review and duration of antibiotic treatments. In each institution, the appropriation of these recommendations should arouse multidisciplinary discussions resulting in better knowledge of local epidemiology, rate of antibiotic use, and finally protocols for improving the stewardship of antibiotics. These efforts should contribute to limit the emergence of resistant bacteria.
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Intensive care medicine · Jul 2015
Review Meta AnalysisGlucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis.
Glucocorticosteroids (steroids) are widely used for sepsis patients. However, the potential benefits and harms of both high and low dose steroids remain unclear. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis (TSA) might shed light on this clinically important question. ⋯ Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking. The results of ongoing and future well-designed, large randomised clinical trials are needed.
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Preeclampsia remains an important cause of avoidable maternal morbidity and mortality. Publication of guidelines and monitoring adherence to life-saving therapies should be prioritized. Prediction of fluid responsiveness requires individual hemodynamic investigation. Future studies are required to determine the optimal early warning system and monitoring tools for providing early and non-invasive hemodynamic assessment.
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Intensive care medicine · Jul 2015
More than half the families of mobile intensive care unit patients experience inadequate communication with physicians.
This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. ⋯ More than half of family members reported inadequate comprehension of information on the patient's severity as communicated by mobile ICU physicians.