Articles: critical-illness.
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Effective antimicrobial therapy remains paramount to successful treatment of patients with critical illness, such as pneumonia and sepsis. Unfortunately, critically ill patients often exhibit altered pharmacokinetics and pharmacodynamics (PK/PD) that make this endeavor challenging. Particularly in sepsis, alterations in volume of distribution (Vd) and protein binding lead to unpredictable effects on serum levels of various antimicrobials. ⋯ Implementing TDM of agents such as piperacillin-tazobactam, cefepime, and meropenem has been suggested as a method of improving time above MIC (T >MIC). This practice is limited by the lack of access to commercial assays and the failure of rigorous studies to demonstrate improved treatment success. Clinicians should be aware of these challenges and should refine their dosing strategies based on individualized patient factors to reduce treatment failure.
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Acta Anaesthesiol Scand · Feb 2022
Health-related quality of life and days alive without life support or out of hospital: protocol.
Mortality is often the primary outcome in randomised clinical trials (RCTs) conducted in critically ill patients. Due to increased awareness on survivors after critical illness and outcomes other than mortality, health-related quality of life (HRQoL) and days alive without life support (DAWOLS) or days alive and out of hospital (DAAOOH) are increasingly being used. DAWOLS and DAAOOH convey more information than mortality, are easier to collect than HRQoL, and are usually assessed at earlier time points, which may be preferable in some situations. However, the associations between DAWOLS-DAAOOH and HRQoL are uncertain. ⋯ The outlined study will provide important knowledge on the associations between DAWOLS-DAAOOH and HRQoL in adult critically ill patients, which may help researchers and clinical trialists prioritise and select outcomes in future RCTs conducted in this population.
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Traumatic stress occurs in children when their coping mechanisms are overwhelmed by exposure to traumatic events or situations. Estimates indicate that as many as 80% of ill and injured children experience traumatic stress after such exposure. Critically ill or injured children are especially at risk for the development of traumatic stress, including acute stress reaction and posttraumatic stress disorder. ⋯ This article presents types of traumatic stress, risk factors for the development of traumatic stress, clinical findings in children and adolescents, and nursing strategies for preventing and managing traumatic stress in pediatric patients. Critical care and acute care nurses are in an excellent position to assess children for symptoms of acute stress reaction and posttraumatic stress disorder during or after a stay in the intensive care unit, to implement strategies to prevent or ease the symptoms of acute stress reaction and posttraumatic stress disorder, and to make appropriate referrals for children and their families after exposure to traumatic stressors.
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Mayo Clinic proceedings · Feb 2022
Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units.
To determine short-term outcomes of patients with alcohol-associated cirrhosis (ALC) admitted to the intensive care unit (ICU) compared with other etiologies of liver disease. In addition, we investigate whether quick sequential organ failure assessment accurately predicts presence of sepsis and in-hospital mortality in critically ill patients with various etiologies of cirrhosis. ⋯ Critically ill patients with ALC have decreased survival after ICU discharge compared with patients with other etiologies of cirrhosis, independent of alcohol abstinence.