Current opinion in critical care
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Despite developments in treatment of myocardial infarction, mortality rates in cardiogenic shock remain unacceptably high. Intra-aortic balloon pumping (IABP) is to date the most used device for hemodynamic support, but randomized evidence on survival benefit was lacking. ⋯ In cardiogenic shock, no general recommendation for IABP can be given. In the next revision of current guidelines, recent randomized trial results should be incorporated. Further research is needed to develop optional treatments in cardiogenic shock or to gain validated algorithms for use of active assist devices.
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Curr Opin Crit Care · Oct 2013
ReviewVentilator-associated events surveillance: a patient safety opportunity.
The Centers for Disease Control and Prevention recently released new surveillance definitions for ventilator-associated events. The new definitions broaden the focus of surveillance from ventilator-associated pneumonia alone to all significant complications of mechanical ventilation. This review will consider the rationale for the new definitions, the studies supporting their development, and their potential benefits for hospital safety programs. ⋯ Ventilator-associated event surveillance is a promising strategy to improve care for ventilated patients by providing hospitals with a broader picture of their true burden of morbid complications and an objective metric to measure the impact of care improvement initiatives. Prospective studies are now needed to define the best strategies to prevent ventilator-associated events and to quantify the extent to which they are preventable.
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Curr Opin Crit Care · Oct 2013
ReviewContinuous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients: where is the evidence?
Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (Pcuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of Pcuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP. ⋯ Continuous controllers of Pcuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of Pcuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.
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Curr Opin Crit Care · Oct 2013
ReviewNew insights into the pathophysiology of cardiogenic shock: the role of the microcirculation.
The ultimate goal of therapy for cardiogenic shock is to restore microcirculatory function and thereby restore the oxygen supply to sustain cellular function. Therapeutic measures mainly focus on improving pressure-derived macrocirculatory parameters. However, it is increasingly clear that to achieve significant progress in treatment, microcirculatory physiopathological mechanisms must be considered. ⋯ Cardiogenic shock induces microcirculatory disorders that can be monitored and influenced in various manners, both pharmacologically and physically. In addition to global hemodynamic optimization, interventions must also ameliorate the microcirculation.
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Although it has been demonstrated that physical functional impairments are common among survivors of critical illness, few studies have proven benefits of intervention. This review will discuss assessment of physical functional impairment, recent and ongoing interventional studies, and implementation of rehabilitation beginning in the ICU, hospital ward, and after hospital discharge. ⋯ Improving physical function for survivors of critical illness will require careful application of current knowledge, as well as rigorous investigation into causes, research methodologies, and implementation of results of future interventional studies.