Critical care : the official journal of the Critical Care Forum
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Echinocandins are indicated as first-line treatment for invasive candidiasis in moderate to severe illness. As sepsis is the main cause of acute kidney injury, the combination of echinocandin treatment and continuous renal replacement therapy (CRRT) is common. Optimizing antibiotic dosage in critically ill patients receiving CRRT is challenging. ⋯ Classically, drugs like echinocandins with high protein binding and predominantly non-renal elimination are not removed by CRRT, indicating that no dosage adjustment is required. However, recent studies report different proportions of echinocandins lost by filter adsorption. Nevertheless, the clinical significance of these findings remains unclear.
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Letter Multicenter Study
Metabolic alkalosis is the most common acid-base disorder in ICU patients.
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Tetanus is becoming rarer in both industrialized and developing nations due to an effective vaccination program. In 2010, the World Health Organization estimated there was a 93% reduction in newborns dying from tetanus worldwide, compared to the situation in the late 1980s. Due to its rarity, many diagnostic delays occur as physicians may not consider the diagnosis until the manifestations become overt. ⋯ It is difficult to conduct trials on different treatment modalities in tetanus due to both logistical and ethical reasons. However, it is imperative that physicians are aware of the best evidence-based treatment strategies currently available to improve the outcome of patients. This review concentrates on analyzing the current evidence on the pharmacological management of tetanus.
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Multicenter Study Observational Study
Prevalence, predictors and outcome of hypofibrinogenaemia in trauma: a multicentre observational study.
Exsanguination due to trauma-induced coagulopathy is a continuing challenge in emergency trauma care. Fibrinogen is a crucial factor for haemostatic competence, and may be the factor that reaches critically low levels first. Early fibrinogen substitution is advocated by a number of authors. Little evidence exists regarding the indications for fibrinogen supplementation in the acute phase. This study aims to estimate the prevalence of hypofibrinogenaemia in a multi-center trauma population, and to explore how initial fibrinogen concentration relates to outcome. Also, factors contributing to low fibrinogen levels are identified. ⋯ Hypofibrinogenaemia is common in trauma and strongly associated with poor outcome. Below an estimated critical fibrinogen concentration value of 2.29 g/L a dramatic increase in mortality was detected. This finding indicates that the negative impact of low fibrinogen concentrations may have been previously underestimated. A number of clinically identifiable factors are associated with hypofibrinogenaemia. They should be considered in the management of massively bleeding patients. Interventional trials with fibrinogen substitution in high-risk patients need to be undertaken.
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Nutrition support of critically ill patients with sepsis is one of the most debated issues among intensivists. The latest international sepsis guidelines recommend the prescription of a low volume of feeds through gastric or intestinal enteral nutrition (EN) for 7 days after admission to the ICU. The data to support such recommendations are scarce, and large trials are needed to clarify this issue. ⋯ The goal of the authors was to assess the impact of various levels of energy and protein administration on mortality at 60 days after ICU admission and on the duration of mechanical ventilation. They found that standard levels of energy and protein recommended by international guidelines for patients in the ICU do also apply to patients with sepsis in the ICU. This is an important finding, which contradicts the current recommendations and beliefs for this subgroup of patients in the ICU and gives a strong rationale for launching a large prospective randomized trial.