Critical care : the official journal of the Critical Care Forum
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The aims of this study were to assess the reliability of circulating cell-free DNA (cf-DNA) concentrations, compared with C-reactive protein (CRP), procalcitonin (PCT) and eosinophil count, in the diagnosis of infections in patients with systemic inflammatory response syndrome (SIRS) and their prognostic values in a cohort of critically ill patients. ⋯ Our data do not support the clinical utility of cf-DNA measurement in critical care patients with SIRS. PCT is of value especially for infection identification in patients with SIRS at admission to the ICU.
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ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. ⋯ The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
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The recent study by Bloos and colleagues demonstrates that early initiation of antimicrobial therapy is not associated with improved survival in sepsis. We contend that these findings should not be surprising. This study is yet another part of the growing case against early and aggressive antimicrobial therapy and highlights the important roles resuscitation and source control play in the management of the septic patient. We suggest that, whenever possible, antimicrobial therapy should we withheld until objective evidence of infection has been obtained.