Current opinion in critical care
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Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles. ⋯ The clinical application of central venous pressure measurement requires a good understanding of the concept of the interaction of the function of the heart with the function of the return of blood to the heart.
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To present the major pathophysiological and diagnostic features of critical illness myopathy (CIM) and polyneuropathy (CIP), and to discuss problems concerning the risk factors for CIM and CIP. ⋯ Basic and clinical research is unraveling the pathophysiological mechanisms of critical illness myopathy and polyneuropathy, and methods for rapid diagnosis are actively investigated. Future studies should better define the population at risk of developing CIM and CIP. In fact, although sepsis, multi-organ failure and steroids are often cited as risk factors, uncertainty remains due to the poor methodological quality of studies, or because of inferences that are exclusively based on animal studies. New simplified diagnostic techniques and machines for electrophysiological investigations of peripheral nerves and muscles in the intensive-care unit (ICU) patient would also be welcome.
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Curr Opin Crit Care · Apr 2005
ReviewIntra-abdominal hypertension in the critically ill: it is time to pay attention.
There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). Comparison of the published data however is difficult due to the lack of consensus definitions. This review will focus on the available literature from the last 2 years. A Medline and PubMed search was performed using 'intra-abdominal pressure' (IAP), 'intra-abdominal hypertension' (IAH), and 'abdominal compartment syndrome' (ACS) as search items. The aim was to find an answer to the question 'Isn't it time to pay attention to intra-abdominal pressure in the critically ill?' ⋯ It is time to pay attention to intra-abdominal pressure in the critically ill. It is also time for standardized IAP measurement methods, good consensus definitions and randomized interventional studies.
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Curr Opin Crit Care · Apr 2005
ReviewEffects of selective decontamination of digestive tract on mortality and antibiotic resistance in the intensive-care unit.
Since its introduction in 1984 several small trials have studied the infection prevention regimen of selective decontamination of the digestive tract (SDD) in intensive care patients. Although meta-analyses of these studies suggested that SDD could reduce mortality, it continued to be a highly controversial strategy. There were not only serious doubts about the methodological quality of the meta-analyses, fear also existed that SDD would lead to increased antibiotic resistance. Recently, two new large randomized trials have been published that studied the effects of SDD on mortality and resistance. In this article, we will review the concept on which SDD is based and the present knowledge of the effects of SDD on mortality and antibiotic resistance. ⋯ There is convincing evidence that selective decontamination of the digestive tract (SDD) lowers mortality as well as resistance in circumstances with low prevalence of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococcus (VRE). SDD should still be considered experimental in area's where MRSA and VRE are endemic. However, given the important potential benefits of SDD, more studies are urgently needed to adapt SDD in a way that proves effective in those settings.
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Curr Opin Crit Care · Apr 2005
ReviewMultimodality monitoring and telemonitoring in neurocritical care: from microdialysis to robotic telepresence.
This review will highlight the state-of-the-art in brain monitoring in neurointensive care and define methods of integrating this technology into patient care using telemedicine methods. ⋯ Multimodality and telemedicine techniques have advanced the state of knowledge about brain function in critically ill patients, and are presently being implemented to direct therapy. Increasing complexity of care will become commonplace, but will be facilitated by computer-enhanced tools that permit the intensivist to integrate this information into an improved treatment regimen.