Current opinion in critical care
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Curr Opin Crit Care · Oct 2015
ReviewMonitoring: from cardiac output monitoring to echocardiography.
Hemodynamic exploration is mandatory in patients with shock to identify the type of shock, to select the best therapeutic strategy, and to assess the efficacy of the selected therapy. In this review, we summarize the characteristics of the main available hemodynamic monitoring systems and emphasize on how to select the most appropriate ones in patients with circulatory shock. ⋯ The use of echocardiography should be encouraged at the initial period of shock to identify main involved mechanisms and to select the appropriate therapy. The use of more invasive monitoring systems should be discussed on an individualized basis.
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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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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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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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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.