Current opinion in critical care
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Burnout syndrome is a psychological state resulting from prolonged exposure to job stressors. Because ICUs are characterized by a high level of work-related stress, a factor known to increase the risk of burnout syndrome, we sought to review the available literature on burnout syndrome in ICU healthcare workers. ⋯ Recent studies reported high levels of severe burnout syndrome in ICU healthcare workers and identified potential targets for preventive strategies such as ICU working groups, communication strategies during end-of-life care and prevention and management of ICU conflicts.
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In the ICU only half of the patients are volume responsive - that is, they respond to fluid administration by increasing their cardiac output. We aim to summarize the methods available for predicting volume responsiveness, focusing on recent findings in patients with spontaneous breathing activity. ⋯ Predicting the hemodynamic response to fluid administration in patients with acute circulatory failure is of major importance and numerous methods are now available. While the respiratory variations of stroke volume (or its surrogates) can be used in patients fully adapted to their ventilator, the passive leg-raising test has become a reliable predictive method in patients with spontaneous breathing activity.
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Curr Opin Crit Care · Oct 2007
ReviewBiomarkers to improve diagnostic and prognostic accuracy in systemic infections.
We review the advantages and drawbacks of biomarkers in the diagnostic and prognostic assessment of systemic infections. ⋯ If used in the proper setting, serial measurements of diagnostic biomarkers may allow treatments to be adjusted at an early stage in patients with severe infections. This may involve either intensifying treatment when infection levels stay high or avoiding unnecessary prolonged courses of antibiotics when levels rapidly decrease, thereby improving the allocation of healthcare resources.
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Curr Opin Crit Care · Oct 2007
ReviewThe role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of brain dysfunction.
Recent investigations demonstrate that most critical care survivors face significant brain-related morbidity including neurocognitive deficits. While current data on neurocognitive outcomes after critical illness are intriguing, gaps in the literature far exceed what we have learned to date. In this paper, we examine important areas of investigation heretofore unaddressed and propose directions for clinically oriented outcomes research. ⋯ Over the last decade, ICU-related cognitive impairment has been identified as a significant public health problem and has become the focus of intense investigation by researchers around the world. While substantial work has been done to date, vitally important questions remain. Future research should evaluate the mechanisms of and risk factors for brain injury, the natural history of neurocognitive dysfunction, structural and functional brain-imaging studies, and therapeutic modalities designed to prevent or decrease neuropsychological disability.
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Curr Opin Crit Care · Oct 2007
ReviewThe role of future longitudinal studies in ICU survivors: understanding determinants and pathophysiology of weakness and neuromuscular dysfunction.
The goals of this review are to discuss the pathophysiology and determinants of muscle weakness and neuromuscular dysfunction after critical illness, and to offer thoughts regarding the role of future longitudinal studies in this area. ⋯ Additional studies with improved methodology that address epidemiology and that test interventions are needed to understand and to improve neuromuscular function after critical illness.