Critical care clinics
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Procalcitonin is a biomarker that is generally elevated in bacterial infections. This review describes a conceptual framework for biomarkers using lessons from the history of troponin, applies this framework to procalcitonin with a review of observational studies and randomized trials in and out of the intensive care unit, and concludes with clinical recommendations and thoughts on how to test a test.
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The role of biomarkers for detection of sepsis has come a long way. Molecular biomarkers are taking front stage at present, but machine learning and other computational measures using bigdata sets are promising. ⋯ The final conclusion is expert opinion, which is not bad but not perfect. Perhaps machine learning will displace expert opinion as the final and most accurate definition for sepsis.
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Critical care clinics · Oct 2019
ReviewDisaster Ethics: Shifting Priorities in an Unstable and Dangerous Environment.
Emergency and critical care medicine are fraught with ethically challenging decision making for clinicians, patients, and families. Time and resource constraints, decisional-impaired patients, and emotionally overwhelmed family members make obtaining informed consent, discussing withholding or withdrawing of life-sustaining treatments, and respecting patient values and preferences difficult. When illness or trauma is secondary to disaster, ethical considerations increase and change based on number of casualties, type of disaster, and anticipated life cycle of the crisis. This article considers the ethical issues that arise when health providers are confronted with the challenges of caring for victims of disaster.
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Critical care clinics · Oct 2019
ReviewPrinciples and Practices of Establishing a Hospital-Based Ebola Treatment Unit.
Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen treatment units may improve case detection, interrupt transmission, and improve staff safety and patient care.