Current opinion in critical care
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Curr Opin Crit Care · Oct 2014
ReviewChronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia.
To discuss recent data on the relationship between chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP). ⋯ COPD is a risk factor for VAP. Future studies should focus on specific preventive measures in this population.
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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
ReviewInfection control measures to decrease the burden of antimicrobial resistance in the critical care setting.
The prevalence of multidrug-resistant organisms (MDROs) in ICUs is increasing worldwide. This review assesses the role of infection control measures, excluding antibiotic stewardship programs, in reducing the burden of resistance in ICUs. ⋯ In the recent years, several high-quality clinical studies have assessed the ability of various infection control measures in reducing the burden of antimicrobial resistance. Significant progress has been made in identifying interventions effective in preventing transmission of MDROs in ICUs, in particular, decolonization. However, it still remains impossible to determine the exact and relative importance of different infection control measures. Any approach must ultimately be tailored to the local epidemiology of the targeted ICU.
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Curr Opin Crit Care · Oct 2014
ReviewOptimal data systems: the future of clinical predictions and decision support.
The purpose of the review is to describe the evolving concept and role of data as it relates to clinical predictions and decision-making. ⋯ Modern electronic medical records create an opportunity to design complete and functional data systems that can support clinical care to a degree never seen before. Such systems are often referred to as 'data-driven,' but a better term is 'optimal data systems' (ODS). Here we discuss basic features of an ODS and its benefits, including the potential to transform clinical prediction and decision support.
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The impact of multidrug-resistant organisms (MDROs) is rising and often underestimated. The epidemiology of MDROs is extremely complex and multifactorial. There is increasing antibiotic resistance, mainly related to antibiotic pressure and patients' characteristics. ⋯ Infections with MDROs can prolong hospital stay, promote antibiotic use and prolong duration of mechanical ventilation. Some points should be further explored in clinical research such as the heterogeneity of healthcare-associated pneumonia and the need of new drug development. Resistance to non fermentative Gram-negative bacilli, rising minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus and spread of MDROs in patients without known risk factors suggest a review of guideline validation, taking into account ecology and severity of patient illness to provide timely and appropriate empiric therapy.