Current opinion in critical care
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Curr Opin Crit Care · Oct 2013
ReviewPrompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?
Failed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. ⋯ Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit.
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Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. ⋯ Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.
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Curr Opin Crit Care · Oct 2013
ReviewConservative initiation of antimicrobial treatment in ICU patients with suspected ICU-acquired infection: more haste less speed.
To review the recent literature supporting the idea that in some patients suspected of having a new ICU-acquired infection, antibiotics can be withheld until evidence to confirm diagnosis is obtained. ⋯ In the ICU, patients without septic shock but suspected of having an ICU-acquired infection may be able to have antibiotics withheld until infection is confirmed using a combination of laboratory, radiologic, and microbiological data.
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Curr Opin Crit Care · Oct 2013
ReviewNovelties in biomarkers for the management of circulatory failure.
The purpose of the present work was to review the literature on the role of biomarkers for the diagnosis, the risk stratification, and the management of circulatory failure. ⋯ Because of the tight association between circulatory and renal failure, we put a special emphasis on cardiovascular [B-type natriuretic peptide (BNP), Nt-proBNP, troponin, QSOX-1, sST-2, mid-regional pro-atrial natriuretic peptide] and renal biomarkers (neutrophil gelatinase-associated lipocalin, cystatin C, liver-type fatty acid-binding protein, kidney injury molecule-1, insulin-like growth factor-binding protein-7, tissue inhibitor of metalloproteinase-2). We also discuss nonspecific biomarkers (pro-ADM, glycemia, MicroRNA, chromogramin A) in this setting. We discuss the potential interest and limits, from diagnosis to prognosis reclassification, of cutting-edge new biomarkers, but also widely available and inexpensive biomarkers, in the particular setting of circulatory failure.
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Curr Opin Crit Care · Oct 2013
ReviewNovelties in pharmacological management of cardiopulmonary resuscitation.
The ultimate goal of cardiopulmonary resuscitation is long-term neurologically intact survival. Despite numerous well-designed studies, the medications currently used in advanced cardiac life support have not demonstrated success in this regard. This review describes the novel therapeutics under investigation to improve functional recovery and survival. ⋯ Although substantial data have shown benefits using robust animal models, further human studies are necessary to investigate the potential long-term benefits of these therapies.