Revue médicale suisse
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Revue médicale suisse · Dec 2005
Review[Strategies targeted at optimising antimicrobial therapy in critically ill patients].
Antibiotics are widely used in critical care and adequate empirical treatments has a significant impact on the outcome of many patients. Most nosocomial infections may be due to multidrug-resistant pathogens and requires empirical borad spectrum coverage before identification of the etiologic agents. This is associated with overuse of antibiotics which contributes to the further increase in multidrug-resistances. In this context, new strategies targeted at antibiotic control, such as guidelines and de-escalation are needed to control this evolution.
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Revue médicale suisse · Dec 2005
Review[The management of the alcohol withdrawal syndrome in the intensive care unit].
The management of the alcoholic withdrawal syndrome in the intensive care unit is difficult. Clearly, the patient must be sedated, in order to avoid the side-effects of agitation, like trauma. However, a too much enthusiastic sedation has to be avoided, first because it may unmask neurologic important information, and, second, because it can prolong or complicate the ICU stay. In this review, we discuss the actual management of the alcoholic withdrawal syndrome in the ICU.
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Revue médicale suisse · Dec 2005
Review[Intensive care unit admission of critically ill cancer patients].
Admission, and non-admission, in intensive care units (ICU) for oncologic patients are discussed in this review. Medical, ethical and economical concerns have to be considered. ⋯ In addition, it is important to be aware that, during the last few years, the prognosis of the oncologic patients treated in the ICU is continuously improving. Therefore, the admission of such patients must be systematically discussed with both the oncologist and the critical care physician.
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Neuropathic pains are frequent with better understood underlying mechanisms. The introduction of a new questionnaire, named DN4 (neuropathic pain 4 questions) will certainly be useful to prevent persistent pain. ⋯ The choice of the drug is based on the type of pain, a predominantly diffused pain being firstly treated with tricyclic antidepressants, whereas paroxysmal and localized pain being more adequately treated with anti-epileptics. Pregabaline, the newest anticonvulsant launched in the Swiss market, appears to be effective as a treatment of painful diabetic polyneuropathy and postherpetic neuralgia.