Current opinion in critical care
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Curr Opin Crit Care · Oct 2006
ReviewGlycaemic control in critically ill patients with cardiovascular disease.
The role of hyperglycaemia in the pathogenesis of myocardial damage during cardiac surgery or patients with acute coronary syndromes has been the subject of increasing interest over the past few years. Several further trials and meta-analyses investigating the role of insulin treatment, either aimed at tight control of blood glucose concentration or as part of a regimen including glucose and potassium, have been reported recently and are the subject of this review. ⋯ Tight control of blood glucose has been shown to be beneficial in several patient groups. The optimal target glucose concentration and glucose and insulin regimens remain to be confirmed or determined in each clinical situation.
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Curr Opin Crit Care · Oct 2006
ReviewMicrocirculatory disorders in sepsis and transplantation: therapy with natural coagulatory inhibitors antithrombin and activated protein C.
Modern technologies allow visualization of microcirculatory disorders. This review describes how the coagulatory inhibitors antithrombin and activated protein C (APC) can improve microcirculation in sepsis and transplantation. ⋯ Microcirculatory dysfunction plays a key role in the development of organ dysfunction in septic patients and after solid organ transplantation. The exogenous application of coagulatory inhibitors may provide a new important strategy for prevention and treatment of microcirculatory disorders. This mode of action may be the reason why coagulatory inhibitors could improve mortality in septic patients without directly influencing inflammatory mediator concentrations.
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Curr Opin Crit Care · Oct 2006
ReviewAssessing neurocognitive outcomes after critical illness: are delirium and long-term cognitive impairments related?
Critically ill patients have a high risk of developing neurologic dysfunction including delirium and long-term cognitive impairment. In this paper we examine possible relationships between delirium and long-term cognitive impairments and explore this in the context of critical illness. ⋯ Potential neurologic consequences of critical illness include delirium and long-term cognitive impairments. Defining the extent of their association in intensive care unit cohorts is an important research priority due to the high prevalence of delirium and persistent cognitive impairments in critically ill patients. Future research should focus on strategies for the early identification of delirium and cognitive impairments, elucidating mechanisms of brain injury, and the development and implementation of therapeutic modalities designed to prevent or decrease delirium and cognitive morbidity.
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To describe the use of a 'de-escalation' strategy to deliver appropriate empiric therapy for ventilator-associated pneumonia, without the overuse of antibiotics. ⋯ De-escalation is a promising strategy for optimizing the responsible use of antibiotics while allowing the delivery of prompt and appropriate empiric therapy of ventilator-associated pneumonia.
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The high costs of critical illness make economic outcomes important adjuncts to clinical outcomes in intensive care unit research. Costs are markedly different than other clinical outcomes, both in their measurement and their interpretation. ⋯ When correctly measured and interpreted alongside measures of effectiveness, costs are a useful and important outcome in critical care research.