Critical care : the official journal of the Critical Care Forum
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Review Comparative Study
Clinical review: non-antibiotic strategies for preventing ventilator-associated pneumonia.
Prevention of nosocomial pneumonia (NP) is the most important step towards reducing hospitalisation costs. The non-antibiotic prevention strategies include measures related to the correct care of the artificial airway, strategies related directly to the maintenance of the mechanical ventilator and the equipment, strategies focused in the gastrointestinal tract, and strategies related to the position of the intubated patients. While simple methods should be part of routine practice, the use of more invasive and expensive preventive measures should be used only in patients who are at high risk of NP. The appropriate use of these techniques can reduce the incidence of NP in intensive care unit patients.
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This review discusses the possible involvement of a variety of genetic polymorphisms on the course of meningococcal disease. It has been shown that several common genetic polymorphisms can either influence the susceptibility to meningococcal disease or can account for a higher mortality rate in patients. Gene polymorphisms concerning antibody receptors, lipopolysaccharide (LPS) binding receptors or proteins, innate complement proteins as well as cytokines and hemostatic proteins are described. The study of genetic polymorphisms might provide important insights in the pathogenesis of meningococcal disease and could make it possible to identify individuals who are at risk of either contracting or dying from meningococcal disease.
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The 8th World Congress saw the presentation of several late-breaking findings, such as the role of insulin in reducing mortality, and technologies such as vital microscopy. There were heated debates for and against the role of gastric tonometry, enteral nutrition, extracorporeal membrane oxygenation, the question of 'closed' or 'open' intensive care units, and several others. The overall message was the need to study outcomes and practise intensive care in a sensitive and humane fashion.
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Comparative Study
Assessment of tissue oxygen tension: comparison of dynamic fluorescence quenching and polarographic electrode technique.
Dynamic fluorescence quenching is a technique that may overcome some of the limitations associated with measurement of tissue partial oxygen tension (PO2). We compared this technique with a polarographic Eppendorf needle electrode method using a saline tonometer in which the PO2 could be controlled. We also tested the fluorescence quenching system in a rodent model of skeletal muscle ischemiahypoxia. ⋯ Measurement of tissue PO2 using fluorescence quenching is at least as accurate as measurement using the Eppendorf needle electrode in vitro, and may prove useful in vivo for assessment of tissue oxygenation.
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Comment Letter Comparative Study
Concerns about the effectiveness of critical incident stress debriefing in ameliorating stress reactions.