Current opinion in critical care
-
Curr Opin Crit Care · Oct 2011
ReviewProbiotics for prevention of nosocomial infections: efficacy and adverse effects.
In this era of increasing antimicrobial resistance, use of probiotics in infection prevention has brought new perspective. However, in 2008 the, until then considered, safe use of probiotics became an important topic after publication of a trial showing excess mortality in patients on probiotic prophylaxis. In this article, we review the concept of infection prevention by probiotics and the present knowledge of the efficacy of probiotics in prevention of infections among patients with abdominal diseases and in intensive care. Safety issues of probiotics will be discussed extensively. ⋯ The efficacy of probiotics in infection prevention among critically ill patients is still not unequivocally determined. The safety profile differs per probiotic strain and should not be generalized towards other strains and patient populations. A well designed and well powered clinical trial with clear endpoints to demonstrate efficacy is warranted.
-
Curr Opin Crit Care · Oct 2011
ReviewUnderstanding health economic analysis in critical care: insights from recent randomized controlled trials.
The article reviews the methods of health economic analysis (HEA) in clinical trials of critically ill patients. Emphasis is placed on the usefulness of HEA in the context of positive and 'no effect' studies, with recent examples. ⋯ Costs and cost-effectiveness are potentially useful outcomes in RCTs of critically ill patients. Future RCTs should incorporate parallel HEA to provide both economic outcomes, which are important to the community, alongside patient-centered outcomes, which are important to individuals.
-
Several alternative treatments have been proposed to decrease mortality of patients with acute respiratory distress syndrome (ARDS). We will discuss most recent trials and meta-analysis studies on nonconventional ventilatory and pharmacological treatments of ARDS patients. ⋯ Existing data suggest that some of the available nonconventional treatments may be effective in more severe ARDS patients. New techniques and drugs that should facilitate prevention or healing of lung injury are under investigation.
-
To re-emphasize the epidemiology, pathophysiology, diagnosis, and treatment of cardiac tamponade. ⋯ Cardiac tamponade is responsible for an obstructive shock. Causes of pericardial effusion are numerous. Echocardiography is the fundamental tool for the diagnosis and therapeutic management. Volume resuscitation and catecholamines are temporary treatments, pericardial drainage remaining the only effective treatment.
-
To review the contemporary management of patients with pulmonary hypertension in critical care. ⋯ This article reviews recent and key findings on the management of pulmonary hypertension in critically ill patients.