Articles: critical-care.
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Twenty trials (17 controlled and three observational cohort studies) on selective decontamination of the digestive tract (SDD) have been undertaken to date. SDD is defined as a technique which aims to eradicate carriage of disease-causing microorganisms by means of lethal oropharyngeal and faecal antimicrobial concentrations. The SDD concept and the criteria for the choice of the antimicrobials used in the SDD programme are explained. ⋯ Two recent trials describe the control of an outbreak with a multiresistant Klebsiella by SDD. There are three indications for the use of SDD so far: (i) in trauma patients; (ii) in certain elective surgical procedures including liver transplantation and oesophageal resection; and (iii) in control of outbreaks of ICU infection. Future lines of research may include a properly designed trial with mortality as endpoint and studies on the transfer of SDD from the ICU into the ward as part of prophylaxis in major surgery.
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The advances in pediatric intensive care outlined here point out the differences between children and adults that need to be considered when taking care of children with surgical diseases. In the past, advances in pediatric critical care have not kept pace with advances in adult care, but these and other new techniques have rapidly closed this gap in knowledge.
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Intensive care has been important in the treatment of cancer patients during the last decade. The main indications for admission to the intensive care unit are postoperative recovery, critical complications of cancer and its treatment, intensive anticancer treatment administration monitoring, and acute disease unrelated to the neoplastic disease or its treatment. Management of such cases must take into account the patient's fragility resulting from the presence of a severe chronic underlying disease with systemic effects. In the future, intensive care may play an important role in the development of oncology not only as supportive care for patients but also in the active development of new anticancer therapies.
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Critical care medicine · Aug 1991
Gastric mucosal pH as a prognostic index of mortality in critically ill patients.
To determine if measurements of gastric intramucosal pH have prognostic implications regarding ICU mortality. ⋯ Measurements of gastric intramucosal pH on ICU admission, and again 12 hrs later, have a high specificity for predicting patient survival in this ICU patient population (77.8% to 80.6%). Furthermore, given its relative noninvasive nature, tonometrically measured gastric intramucosal pH may be a useful addition to patient monitoring in the ICU.