Current opinion in critical care
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Curr Opin Crit Care · Oct 2009
ReviewAerosolized antibiotics in critically ill ventilated patients.
This review will summarize recent clinical data examining the efficacy of aerosolized antimicrobial therapy in treating respiratory tract infections in mechanically ventilated patients in the ICU. ⋯ Aerosolized antibiotic therapy may provide an efficacious means of treating respiratory tract infection when targeted at mechanically ventilated patients with proximal airway infection, VAT (with or without VAP) and with highly resistant organisms.
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Prognostic models for predicting outcome after severe traumatic brain injury (TBI) may be useful in several areas. However, established risk prediction models for general critical illness show significant limitations in neurotrauma. Development of specific risk prediction models for TBI has been difficult due to the variability of injury, which predicates a large sample for construction of robust models. Previous development of prognostic models for TBI has suffered from small sample sizes, poor study design and follow up, difficulty in application to clinical practice, limited inclusion of patients from low income countries, and lack of external validation. ⋯ The outcome prediction models that have evolved from these databases are undergoing further refinement and validation, and it is likely that these advances will prove valuable in training clinicians, counselling patients' families, auditing unit performance, designing better clinical trials, and rational allocation of resources.
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Severe sepsis and septic shock are among the most important causes of morbidity and mortality in patients admitted to the intensive care unit. The purpose of this review is to review current understanding of sepsis-induced cardiac dysfunction and discuss pertinent findings regarding its clinical presentation, underlying mechanisms of disease, and therapy. ⋯ Cardiac dysfunction is common in patients with severe sepsis and septic shock. Current understanding of the underlying mechanisms responsible is rapidly evolving and future novel therapeutic targets may be soon available. Present therapy for sepsis-induced cardiac dysfunction is based on treatment of underlying sepsis with antibiotics and hemodynamic support.
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The article reviews and speculates on potential mechanisms underlying sex-related differences in admission patterns, care delivery and outcome of critical illness. ⋯ Sex differences in incidence of critical illness and provision of care exist but it is unclear whether they relate to differences in risk factors, or differences in decision-making among patients, surrogates or healthcare professionals.