Current opinion in critical care
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Curr Opin Crit Care · Oct 2007
ReviewInterventions to prevent transmission of antimicrobial-resistant bacteria in the intensive care unit.
Healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), and multidrug resistant Gram negative bacilli are a serious problem in ICUs. This review analyzes recent reports of interventions to prevent transmission of these organisms in the ICU. ⋯ Progress is being made in identifying interventions to prevent transmission of antimicrobial resistant bacteria in ICUs, although the strength of the evidence is limited compared with many therapeutic interventions. Large MRSA control initiatives launched during 2006 and 2007 may build on this work; their effects should be evaluated using proper study designs and analyses.
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Curr Opin Crit Care · Oct 2007
Seven lessons from 20 years of follow-up of intensive care unit survivors.
Through a personal narrative, the authors discuss the lessons they have learned from 20 years of intensive care follow-up and rehabilitation. ⋯ The need and demand for care after critical illness is now firmly established.
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Fluid (volume) therapy is an integral component in the management of critically ill patients and fluid management may influence outcome. There is much controversy, however, about the type, timing and amount of fluid therapy. Here, we discuss the evidence available to guide such choices. ⋯ Emerging evidence shows that choice, timing and amount of fluid therapy affect outcome. Future studies need to focus on these aspects of fluid therapy by means of larger, more rigorous and blinded controlled trials.
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Curr Opin Crit Care · Oct 2007
ReviewPercutaneous left ventricular assist devices for treatment of patients with cardiogenic shock.
This review will discuss the rationale and clinical utility of percutaneous left ventricular assist devices in the management of patients with cardiogenic shock. ⋯ The advent of percutaneous left ventricular assist devices constitutes an important advance in the management of patients with severe cardiogenic shock and may serve as bridge to recovery or heart transplantation in carefully selected patients. While improvement of hemodynamic parameters appears promising, it remains to be determined whether this benefit translates into improved clinical outcome.
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To highlight the major advances in diagnosing and preventing catheter-related infections published in research articles published between March 2004 and May 2007. ⋯ Nowadays, multimodal programs of catheter infection prevention are efficacious. Levels of catheter-related bloodstream infection of more than one or two per 1000 catheter-days are usually only found in the intensive care unit. It is a prerequisite to evaluate the cost-effectiveness of new techniques of prevention. As catheter-related bloodstream infections become rarer, strategies limiting unnecessary removal of catheters need to be developed and tested.