Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 1994
ReviewMediator-specific therapies for the systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock: present and future approaches.
Despite recent advances in critical care and cardiopulmonary support, mortality from septic shock and its complications remains high. Effective therapies are needed to halt the progression of SIRS and the septic cascade prior to development of shock and organ ischemia/dysfunction. Such therapies are directed at prevention of infection/endotoxemia and modulation of mediators. These therapies are the focus of this article.
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Crit Care Nurs Clin North Am · Jun 1994
ReviewThe systemic inflammatory response, sepsis, and multiple organ dysfunction: new definitions for an old problem.
Sepsis is one of the leading causes of morbidity and mortality in the United States. Until recently, there was much variation in the definition and descriptions of sepsis. This article outlines the report of the consensus conference between the Society of Critical Care Medicine and the American College of Chest Physicians, which established recommendations for the terminology to be used when describing sepsis. An overview of the epidemiology of sepsis and the current state-of-the-art therapy are also provided.
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Crit Care Nurs Clin North Am · Jun 1994
ReviewPathophysiology, monitoring, and therapy of acute circulatory problems.
Acute circulatory problems, including shock, traditionally have been recognized and treated by subjective symptoms and vital signs (BP and HR) which represent only superficial aspects of the underlying physiology. Shock, however, is objectively diagnosed, evaluated, and treated using invasive physiologic monitoring to measure cardiac function and output, pulmonary function, and tissue perfusion. Multicomponent noninvasive monitoring systems are now being developed to obtain comparable information and provide continuous display of data on-line, in real time. These monitoring systems may be used to evaluate the effectiveness of alternative therapies, and to titrate therapy to achieve optimal physiologic goals that improve outcome.
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Crit Care Nurs Clin North Am · Jun 1994
ReviewAnti-infective drugs in the prevention and treatment of sepsis syndrome.
Anti-infective drugs may be used to prevent or treat infectious diseases. Preventing serious infections using aerosolized drugs, selective decontamination of the intestinal tract, or devices impregnated with anti-infective materials generally has been unsuccessful. Treatment of serious infections arising from the community or hospital setting requires knowledge of the most likely pathogens responsible for the illness, the antimicrobial susceptibility of those organisms, and the proper dosing of antimicrobial therapy.
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Sepsis and organ failure are significant causes of morbidity and mortality in the geriatric patient. A number of factors contribute to increased risk of septic complications in the elderly. ⋯ Atypical presentation is also common with infection in the elderly. The key to blunting the effects of severe infection in the elderly is rapid diagnosis and aggressive resuscitation.