Current opinion in critical care
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Therapeutic hypothermia following out-of-hospital cardiac arrest improves neurological recovery. Coupled with neurological benefit, multiple complications including infection have been associated with therapeutic hypothermia following out-of-hospital cardiac arrest. In this review, we will discuss therapeutic hypothermia, and more broadly, temperature management, as a risk for ICU infection. ⋯ Studies demonstrate increased rate of pneumonia and bacteremia but decreased rate of other infections, suggesting redistribution but no overall increased risk of infection per se. The diagnosis of infection during therapeutic hypothermia does not impact mortality or neurological recovery.
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To describe why the prediction of ICU outcomes is essential to underpin critical care quality improvement programmes. ⋯ Risk-adjusted mortality has strong support from the critical care community as a quality indicator for benchmarking ICU performance but is dependent on up-to-date, accurate risk models. ICU outcome prediction can also contribute to both randomized and nonrandomized research and potentially contribute to individual patient management, although generic risk models should not be used to guide individual treatment decisions.
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Curr Opin Crit Care · Oct 2014
ReviewFluid removal in acute heart failure: diuretics versus devices.
Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence evaluating their use. ⋯ Decongestion remains a major challenge in acute heart failure. Although recent studies provide useful data to guide practice, the relatively poor outcomes point to the continued need to identify better strategies for safe and effective decongestion.
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Because of heart-lung interactions, weaning from mechanical ventilation induces strong hemodynamic changes that can lead to weaning-induced cardiac failure. Cardiac patients are particularly at risk for this complication. In this review, we will summarize the most recent advances concerning the mechanisms, diagnosis and treatment of weaning-induced cardiac failure. ⋯ Nowadays, the diagnosis of weaning-induced pulmonary edema can be easily made. Identifying such an event is important as an appropriate treatment, guided by the suspected mechanisms leading to the cardiac failure, should hasten weaning from mechanical ventilation.