Current opinion in critical care
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Curr Opin Crit Care · Oct 2011
ReviewCurrent insights in sepsis: from pathogenesis to new treatment targets.
Sepsis continues to be a leading cause of ICU death. This review summarizes current knowledge on sepsis pathogenesis and new therapeutical strategies. ⋯ Sepsis can be seen as a PRR-mediated dysregulation of the immune system following pathogen invasion in which a careful balance between inflammatory and anti-inflammatory responses is vital. Detailed knowledge of host response pathways and new approaches in sepsis trial design, which take into account patient heterogeneity and the phase of the immunological response, represent major steps forward in sepsis research.
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Curr Opin Crit Care · Oct 2011
ReviewTrends in antimicrobial resistance in intensive care units in the United States.
Antimicrobial resistance and a paucity of new antimicrobial agents are ongoing challenges. This review focuses on the major epidemiologic trends and novel treatments, when available, for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, Clostridium difficile, and multidrug-resistant Gram-negative bacilli in the United States during 2010-2011. ⋯ Antimicrobial resistance, particularly among Gram-negative bacilli, continues to increase at a rapid rate. Given the frequent transfer of patients between outpatient and acute care settings, as well as between different geographic regions, coordinated infection control interventions are warranted.
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The scope of this review is to describe what is known about injury outcomes and the principles by which they can be improved by acute phase interventions. Assessing which outcomes matter to trauma patients is important both for the evaluation of existing and novel acute interventions and to assess the delivery of care within trauma systems' performance improvement frameworks. ⋯ Improving outcomes in the acute phase of trauma care requires the timely delivery of complex interventions with an organized trauma system. Research is needed both in developing novel interventions and in developing and validating patient-centred and surrogate outcome tools.
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To discuss recent data relating to survival rates after cardiac arrest and interventions that can be used to optimize outcome. ⋯ In several centres, survival rates following OHCA are increasing. All links in the chain of survival must be optimized if a good-quality neurological outcome is to be achieved.
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To critically discuss the attributable mortality of ventilator-associated pneumonia (VAP) and potential sources of variation. ⋯ Attributable mortality of VAP is about 6%. Accurate diagnostic methods are key to properly estimating it. Traditional statistical models should no longer be used to estimate it. Prevention efforts targeted on patients with intermediate severity may result in the most important outcome benefits.