Critical care medicine
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Critical care medicine · Aug 2010
ReviewRecognition and prevention of nosocomial invasive fungal infections in the intensive care unit.
Despite recent advances in antifungal treatments, the morbidity and mortality of fungal infections, especially invasive candidiasis, in patients in the intensive care unit setting remain high. Because of this, there has been a great interest in improving the evaluation, risk assessment, and prevention of fungal infections in the intensive care unit. ⋯ The introduction of several prediction rules has helped to guide clinicians in the use of prophylaxis or preemptive antifungal therapy in high-risk patients. However, the most immediate benefit has been realized with the introduction of new antifungal agents that have proved to be safer than those available in the past.
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Critical care medicine · Aug 2010
Patients with acute pancreatitis complicated by organ failure show highly aberrant monocyte signaling profiles assessed by phospho-specific flow cytometry.
To outline signaling profiles and transmigration capacity of monocytes of patients with severe acute pancreatitis. ⋯ In severe acute pancreatitis, monocytes show impaired nuclear factor kappaB and STAT1 activation, which may increase susceptibility to secondary infections. p38 activation is normal and STAT3 activation is depressed, which may contribute to maintenance of systemic inflammation. Extracellular signal-regulated kinases 1/2 activation is impaired, which may depress monocytes' transmigration and may consequently increase risk of infection. Monitoring of monocyte signaling profiles may aid in finding new therapeutic approaches and predictors of outcome of severe acute pancreatitis.
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Critical care medicine · Aug 2010
Using evidence, rigorous measurement, and collaboration to eliminate central catheter-associated bloodstream infections.
Healthcare-associated infections are common, costly, and often lethal. Although there is growing pressure to reduce these infections, one project thus far has unprecedented collaboration among many groups at every level of health care. After this project produced a 66% reduction in central catheter-associated bloodstream infections and a median central catheter-associated bloodstream infection rate of zero across >100 intensive care units in Michigan, the Agency for Healthcare Research and Quality awarded a grant to spread this project to ten additional states. ⋯ The model in this program balances the tension between being scientifically rigorous and feasible. The three main components of the model include translating evidence into practice at the bedside to prevent central catheter-associated bloodstream infections, improving culture and teamwork, and having a data collection system to monitor central catheter-associated bloodstream infections and other variables. If successful, this program will be the first national quality improvement program in the United States with quantifiable and measurable goals.
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Critical care medicine · Aug 2010
Comparative StudyRole of regulatory T cells in long-term immune dysfunction associated with severe sepsis.
To investigate the role of regulatory T cells in the modulation of long-term immune dysfunction during experimental sepsis. It is well established that sepsis predisposes to development of a pronounced immunosuppression. Nevertheless, the mechanisms underlying the immune dysfunction after sepsis are still not well understood. ⋯ These findings suggest that regulatory T cells play an important role in the progression and establishment of immune dysfunction observed in experimental sepsis.