Critical care clinics
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Critical care clinics · Apr 2000
ReviewImmunologic response to infection and its role in septic shock.
In summary, the invasion of bacteria across mucosal surfaces is met with a vigorous host response that includes complement, antibody formation (thymus-independent and eventually thymus-dependent), phagocytosis, production of antibacterial peptides and proteins, the production of cytokines that result in activation of phagocytes and endothelial cells to attract more phagocytes, and the formation of fibrin to limit the spread of infection. The best summary of immune response to infection was written by Lewis Thomas in 1974.
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Critical care clinics · Apr 2000
ReviewScoring systems for assessing organ dysfunction and survival.
Sepsis is an ongoing disease process carrying a high risk of organ failure and death. Scoring systems to determine disease severity and risk of mortality may be useful in patient management and clinical trial enrollment, although the role of either type of score in the determination of admission or discharge criteria or in decisions relating to the continuation or withholding of treatment remains controversial. General scoring systems have been developed to quantify the severity of illness and the risk of mortality in ICU patients. ⋯ Organ function scores, however, can be assessed repeatedly and used to define a patient's progress. This approach can thus be used to evaluate individual patient care, to identify patients for enrollment in clinical trials or epidemiologic analyses, and to assess morbidity measures in clinical trials of new interventions. Organ dysfunction scores are just that, descriptors of organ dysfunction, and although high values correlate well with mortality, prognostication is not their prime aim; organ dysfunction scores and outcome prediction scores should rather be viewed as complementary systems in the description of ICU populations.
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This article examines the spectrum of metabolic alterations in sepsis and septic shock. The clinical manifestations, neuroendocrine control, and bioenergetics of the "ebb" and "flow" phases of sepsis are reviewed. Characteristic alterations in carbohydrate, fat, and protein metabolism induced by sepsis are outlined. Finally, the implications of these metabolic alterations for the nutritional support of patients with sepsis are discussed.
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Critical care clinics · Apr 2000
ReviewSevere sepsis and septic shock. Definitions, epidemiology, and clinical manifestations.
Severe sepsis and septic shock are frequently encountered conditions in today's hospital environment. The incidence appears to be increasing despite our growing armamentarium of antibiotics and our enhanced knowledge of the pathophysiologic processes at play. ⋯ A high index of suspicion and prompt institution of appropriate antimicrobial treatment is mandatory for a successful outcome. It is hoped that adoption of uniform definitions will aid in research and in effective communication concerning sepsis and its adverse sequelae.
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Critical care clinics · Jan 2000
ReviewMinimally invasive surgery. Bedside tracheostomy and gastrostomy.
Minimally invasive surgical techniques have gathered tremendous momentum. Most patient benefit is realized in the ambulatory setting. Smaller incisions result in less pain and earlier return to activities. ⋯ Devastating complications can become life-threatening. Attention to detail is required to avoid or respond promptly to complications. In this way, patients receive maximal benefit at minimal risk.