Current opinion in critical care
-
Traditionally, hospitals have coped with chronically high ICU census by building more ICU beds, but this strategy is unlikely to be tenable under future financial models. Therefore, ICUs need additional tools to manage census, inflow, and throughput. ⋯ ICUs should actively manage throughput and census. Operations management tools such as Little's Law can provide practical guidance about the relationship between census, throughput, and patient demand. Standard ICU quality improvement techniques can meaningfully affect both ICU census and throughput.
-
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.
-
Curr Opin Crit Care · Oct 2011
ReviewMechanical assistance of the circulation during cardiogenic shock.
Cardiogenic shock still has a grave prognosis. We present the recent advances in mechanical circulatory support (MCS) for the treatment of refractory cardiogenic shock. ⋯ Although MCS can be life saving in cardiogenic shock, the results are still suboptimal. Mortality is associated with the critical presupport state and the adverse events during MCS. Early initiation of support that meets the patient's requirements, potent support in the early phase, adverse event prevention, global combined management (surgical, interventional, medical), balanced support duration, bridging to further therapeutic modalities including heart transplantation or longer-term support, and advanced technology could offer improved results.
-
Curr Opin Crit Care · Oct 2011
ReviewPerioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients.
Cardiac complications after noncardiac surgery cause significant morbidity and mortality. This review will discuss recent developments in risk stratification, monitoring, and risk reduction strategies. ⋯ Systematic preoperative assessment can identify patients at high risk of cardiac complications and guide the application of appropriate risk reduction strategies.