Current opinion in critical care
-
The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs. ⋯ Outcomes from HICs cannot be reliably extrapolated to LMICs, so it is important to study outcomes for critically ill patients in LMICs. Specific challenges to achieving meaningful outcomes studies in LMICs include defining the critically ill population when few ICU beds exist, the resource-intensiveness of long-term follow-up, and the need for reliable severity of illness scores to interpret outcomes. Although much work remains to be done, examples of studies overcoming these challenges are beginning to emerge.
-
Curr Opin Crit Care · Oct 2018
ReviewDo we need biomarkers for the follow-up and shortening of antibiotic treatment duration?
Clinical and laboratory parameters are useful tools for the diagnosis, follow-up and evaluation of resolution, and to predict outcomes when measured at different time-points onset and serially during follow-up in patients with hospital-acquired pneumonia and/or ventilator-associated pneumonia (HAP/VAP). ⋯ Current evidence indicate that there is no recommendation to use biomarkers systematically to guide every decision. However, in some circumstances they might add some relevant information to our everyday practice.
-
Curr Opin Crit Care · Oct 2018
ReviewDiagnosis of nonventilated hospital-acquired pneumonia: how much do we know?
To describe the current knowledge about clinical and microbiological diagnosis of nonventilated hospital-acquired pneumonia (NV-HAP). ⋯ NV-HAP poses several barriers for diagnosis compared with VAP, and the available knowledge is limited. A call for further research in diagnosis of nonventilated HAP is urgent.
-
In this review, we will discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. We shall discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers. ⋯ A theoretical framework is outlined to help understand the impact of critical care interventions on outcomes that are meaningful to patients, families and healthcare providers.
-
Curr Opin Crit Care · Oct 2018
ReviewAntibiotic treatment of hospital-acquired pneumonia: is it different from ventilator-associated pneumonia?
Hospital-acquired pneumonia (HAP) is a form of nosocomial pneumonia, distinct from ventilator-associated pneumonia (VAP). This review compares HAP and VAP, highlighting differences in natural history, risk factors, and bacteriology that necessitate a different approach to the therapy of HAP, compared with VAP. ⋯ Although more prospective therapy trials of HAP are needed, based on currently available data, it is possible to use an approach that provides appropriate therapy without the overuse of broad-spectrum therapy.