Current opinion in critical care
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Curr Opin Crit Care · Oct 2006
ReviewNew diagnostic and prognostic markers of ventilator-associated pneumonia.
The purpose of this review is to analyze the potential advantages and drawbacks of using biomarkers of bacterial infection for the diagnosis and prognosis of ventilator-associated pneumonia. ⋯ Procalcitonin and sTREM-1 should be used only as a complementary tool, to reinforce the usual diagnostic work-up. However, serial serum procalcitonin and sTREM-1 measurements may provide an opportunity to change the treatment early in the course of patients with ventilator-associated pneumonia, either to intensify treatment when their levels stay high, or to avoid unnecessary prolonged courses of antibiotics when their levels rapidly decrease. Whether procalcitonin and/or sTREM-1 guidance can reduce antibiotic use in such a setting will require additional studies, but such a strategy appears promising.
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Curr Opin Crit Care · Oct 2006
ReviewGlycaemic control in critically ill patients with cardiovascular disease.
The role of hyperglycaemia in the pathogenesis of myocardial damage during cardiac surgery or patients with acute coronary syndromes has been the subject of increasing interest over the past few years. Several further trials and meta-analyses investigating the role of insulin treatment, either aimed at tight control of blood glucose concentration or as part of a regimen including glucose and potassium, have been reported recently and are the subject of this review. ⋯ Tight control of blood glucose has been shown to be beneficial in several patient groups. The optimal target glucose concentration and glucose and insulin regimens remain to be confirmed or determined in each clinical situation.
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The high costs of critical illness make economic outcomes important adjuncts to clinical outcomes in intensive care unit research. Costs are markedly different than other clinical outcomes, both in their measurement and their interpretation. ⋯ When correctly measured and interpreted alongside measures of effectiveness, costs are a useful and important outcome in critical care research.
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Curr Opin Crit Care · Oct 2006
ReviewMeasuring the quality of dying and death: methodological considerations and recent findings.
While the need to improve the quality of dying and death in critical settings has been well accepted, there is less agreement on which measures and criteria are best used to assess it. In this article, we present methodological considerations and recent findings that pertain to the measurement of the quality of dying and death. ⋯ These findings suggest a need to integrate both types of measures in research on the quality of end-of-life experiences. This integration, with attention to important methodological issues, may represent a significant step toward improving patients' experiences at the end-of-life.
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Staff satisfaction has not traditionally been included as an intensive care unit quality indicator. The process of providing intensive care may profoundly affect clinicians. Dysfunctional encounters with coworkers and ethical burdens may extract a considerable personal toll and affect work attitudes and performance. ⋯ Two common sources of staff dissatisfaction are examined. Improving staff satisfaction can improve unit performance, and serve to attract and retain quality clinicians.