Current opinion in critical care
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Curr Opin Crit Care · Oct 2015
ReviewDescribing and measuring recovery and rehabilitation after critical illness.
Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data. ⋯ Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
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The contribution of qualitative methods to evidence-based medicine is growing, with qualitative studies increasingly used to examine patient experience and unsafe organizational cultures. The present review considers qualitative research recently conducted on teamwork and organizational culture in the ICU and also other acute domains. ⋯ Qualitative methods highlight the complex nature of risk management in hospital wards, which is highly contextualized to the demands and resources available, and influenced by multilayered social contexts. In addition to augmenting quantitative research, qualitative investigations enable the investigation of questions on social behaviour that are beyond the scope of quantitative assessment alone. To develop improved patient-centred care, health professionals should therefore consider integrating qualitative procedures into their existing assessments of patient/staff satisfaction.
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Curr Opin Crit Care · Oct 2015
ReviewFungal infections in the ICU: advances in treatment and diagnosis.
The aim of this review is to give an update on the available diagnostic approaches and currently adopted therapeutic management of severe fungal diseases in the ICU setting. ⋯ Critically ill patients may frequently experience severe invasive fungal infections. Biomarkers-based diagnostic approaches give, at the same time, the possibility to early detect the ongoing infection and reduce inappropriate antifungal therapy in nonconfirmed cases. Potent and well tolerated drugs are now available for the treatment of proven cases but clinicians should carefully consider the risk of treatment failure and the availability of new monitoring and therapeutic tools.
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To highlight the importance of escalating pathogen resistance in ventilator-associated pneumonia (VAP) along with diagnostic and treatment implications. ⋯ Clinicians should be aware of risk factors for multidrug-resistant pathogens causing VAP and also of particularities of diagnosis and treatment of this important clinical entity.
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Curr Opin Crit Care · Oct 2015
ReviewPharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill.
Antimicrobials are very commonly used drugs in the intensive care setting. Extensive research has been conducted in recent years to describe their pharmacokinetics/pharmacodynamics in order to maximize the pharmacological benefit and patient outcome. Translating these new findings into clinical practice is encouraged. ⋯ Optimization of antimicrobial dosing in accordance with pharmacokinetics/pharmacodynamics targets can improve survival and clinical cure. Dosing regimens for critically ill patients should aim for pharmacokinetics/pharmacodynamics target attainment by utilizing altered dosing strategies including adaptive feedback using therapeutic drug monitoring.