Critical care medicine
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Although bloodstream infection commonly results in critical illness, population-based studies of the epidemiology of severe bloodstream infection are lacking. We sought to define the incidence and microbiology of severe bloodstream infection (bloodstream infection associated with intensive care unit admission within 48 hrs) and assess risk factors for acquisition and death. ⋯ Bloodstream infections are commonly severe enough to require management in an intensive care unit and are associated with a high mortality rate. Identification of risk factors for severe bloodstream infection may allow targeting of preventive efforts to individuals at greatest potential benefit.
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Critical care medicine · Apr 2004
Clinical Trial Controlled Clinical TrialProspective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates.
To determine whether the introduction of an intensive care unit-based medical emergency team, responding to hospital-wide preset criteria of physiologic instability, would decrease the rate of predefined adverse outcomes in patients having major surgery. ⋯ The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes, postoperative mortality rate, and mean duration of hospital stay.
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Critical care medicine · Apr 2004
ReviewAssessment and management of patients with ischemic heart disease.
Review the perioperative management of patients who are scheduled for noncardiac surgery. ⋯ Patients with ischemic heart disease who undergo noncardiac surgery are at significant risk of perioperative cardiac morbidity and mortality. Recent joint guidelines from the American College of Cardiology and American Heart Association have significantly streamlined the preoperative evaluation processes. Augmented hemodynamic control with intensive perioperative pharmacologic therapy with beta-blockers and possibly alpha-2 agonist has been shown to improve perioperative cardiovascular outcomes. However, translating this information to clinical practice continues to be a challenge and requires a multi- disciplinary approach. A particular intraoperative anesthetic technique is unlikely to influence perioperative cardiac morbidity and mortality. Postoperative management with goals of decreasing hemodynamic stress is important in patients with ischemic heart disease. Diagnosis and management of perioperative myocardial infarction continues to be a challenge. However, use of cardiac specific biomarkers should improve the diagnostic process.
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Critical care medicine · Apr 2004
ReviewPreoperative assessment and management to prevent complications during high-risk vascular surgery.
Most patients requiring vascular surgical reconstruction are at high risk for major morbidity and mortality, with certain vascular procedures at particularly high risk for complications. Although numerous comorbid conditions are precisely the risk factors that determine outcome, we review particular factors for each surgery that may be optimized to alter outcome and minimize postoperative complications. ⋯ Patients needing vascular surgery often possess management challenges that increase the risk of perioperative complications. Meticulous attention to details during all phases of care, including preoperative optimization as well as intraoperative procedural conduct and communication, helps achieve optimal results and thus minimize the risk of complications.
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Critical care medicine · Apr 2004
Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia.
To prospectively evaluate the predictive factors for the nonresponse to empirical antibiotic treatment and mortality in patients with intensive care unit-acquired pneumonia. ⋯ Increased systemic inflammatory response was the main predictor of nonresponse to treatment and mortality.