Current opinion in critical care
-
Severe sepsis and septic shock are common causes of morbidity and mortality in critically ill patients. The complexities of the septic cascade continue to emerge and may identify new targets for innovative patient management. This review will highlight some of the recent advances in our management of the patient with sepsis. ⋯ Significant advances have been made in our understanding of the septic cascade and our ability to manage patients with severe sepsis and septic shock. Despite these advances, significant morbidity and mortality continue. In addition, there is also considerable impact on the financial and overall function of the patient.
-
The genetic risk for pneumonia, sepsis, and other serious infections is generally unrecognized or underestimated. Although the strongest evidence for a genetic risk comes from an adoptee study, most evidence for a genetic role in infection involves association studies, which compare the incidence of specific mutations in a population with infection to a control population. Recent association studies in pneumonia and sepsis will be reviewed. ⋯ A genetic component to risk of sepsis and resultant complications clearly exists. Confirmation of the findings in this review and associations with other genetic polymorphisms await large-scale population studies and further validation of the physiologic significance of the variant alleles.
-
This review examines the various techniques used to diagnose ventilator-associated pneumonia. The ideal diagnostic test not only helps the clinician to recognize whether pneumonia is present, but also to influence clinical outcome. ⋯ Diagnostic testing for ventilator-associated pneumonia can identify those patients at risk for a poor clinical outcome.
-
Curr Opin Crit Care · Oct 2003
ReviewIs there an optimal hemoglobin value in the cardiac intensive care unit?
Anemia is common in patients admitted to the cardiac intensive care unit. Many unique issues must be considered in the treatment of the anemic cardiac patient. Coronary artery disease and left ventricular dysfunction may significantly increase the risk of anemia. ⋯ Pending definitive clinical trials in cardiac patients, we suggest a more aggressive transfusion trigger (9-10 g/dL) in patients with active cardiac disease. Pulmonary edema may be precipitated by transfusion in patients with left ventricular dysfunction. Large clinical trials are urgently needed to determine optimal transfusion thresholds in patients with cardiovascular disease.
-
Curr Opin Crit Care · Oct 2003
ReviewInflammatory biomarkers of the patient with myocardial insufficiency.
Inflammation plays a central role in the genesis of atherosclerosis and its complications. In this regard, plasma levels of several markers of inflammation have been shown to predict risk of future cardiovascular events, including cardiovascular death, myocardial infarction, and ischemic stroke. Furthermore, the predictive value of inflammatory markers is independent of traditional risk markers such as lipid levels, or cardiac troponin levels among those with acute coronary syndromes. ⋯ Combining our evolving understanding of the vascular biology of atherosclerosis with clinical studies of inflammatory markers and mediators may help refine our diagnostic and therapeutic armamentarium for cardiovascular disease.