Current opinion in critical care
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Curr Opin Crit Care · Oct 2007
ReviewPatient and caregiver counselling after the intensive care unit: what are the needs and how should they be met?
To examine current research on the psychological needs of both patients and their families following critical illness, and discuss how these may be met in a cost-effective manner. ⋯ Currently, there is an awareness of the psychological sequelae of critical illness for patients and their family caregivers, and with this a responsibility to assess and appropriately help those who are unable to manage their distress. The development and application of specialist psychological services after an episode of critical illness, possibly using a stepped care model, is in its infancy. There are a few centres of excellence that are currently employing these resources, but the vast majority of patients and their families are left to cope on their own. This lack of psychological support has important implications for long-term recovery and quality of life following the episode of critical illness.
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Continuous infusion of beta-lactam antibiotics is becoming increasingly popular. The background and current clinical evidence are discussed. Tools to apply continuous infusion are analyzed. ⋯ Killing of bacteria by beta-lactam antibiotics is maximal at around four times the minimum inhibitory concentration in vitro. To ensure an optimal effect when treating severe infections, free unbound concentrations at or above four times the minimum inhibitory concentration should be maintained. Although continuous infusion has been demonstrated to be superior in animal studies, randomized clinical trials have failed to confirm this in humans, primarily because of suboptimal design. A better designed randomized clinical trial, set up as a pilot study, recently demonstrated a favorable outcome with continuous infusion. A major issue during continuous infusion is the stability of the antibiotic, which may limit its application. The calculation of the infusion rate necessary to obtain the desired free drug concentration is relatively straightforward.
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Curr Opin Crit Care · Oct 2007
ReviewHealth policy and future planning for survivors of critical illness.
Few health policy decisions directly address the needs of intensive care unit survivors. This review will assess some of the health system-level barriers to effective post-intensive care unit care and provide a framework for policy decisions directed at improving outcomes for survivors of critical illness. ⋯ Advances in our understanding of the long-term outcomes of critical illness must be accompanied by healthcare system changes designed to meet the specific needs of intensive care unit survivors.
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Until recently the right ventricle's role in myocardial dynamics has not been fully appreciated. This article provides an overview of the pathophysiology, imaging and management of right ventricular dysfunction. ⋯ Acute right ventricular dysfunction is relatively common. There is a lack of convincing evidence in favour of any single treatment modality. Imaging methods now permit a more accurate evaluation of the right ventricle and its function. Combining treatments may offer significant advantages and the imaging and monitoring available allows real-time assessment of the response to intervention. This article illustrates how incomplete our knowledge of this condition and its management within the critical care setting is and reinforces previous calls for suitably designed trials to evaluate and develop guidelines for existing strategies and therapeutic agents.
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Curr Opin Crit Care · Oct 2007
ReviewInterventions to improve long-term outcomes after critical illness.
The aim of this article is to review the literature specifically on interventions that are targeted at improving health related quality of life in survivors of critical illness. Although there is a growing literature describing the impairment in quality of life of survivors of critical illness, there are a considerably smaller number of studies describing effective interventions at treating or preventing these complications. The topic is complex because critical illness spans a number of diseases including spinal cord injury and myocardial infarction that have an extensive rehabilitation literature. ⋯ Research interest in developing interventions to improve long-term outcome after critical illness is in its infancy and it is too early to make strong clinical recommendations. Multiple potential treatment areas exist both within the ICU and after patients leave the hospital for intensivists to target.