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Minerva anestesiologica · Dec 2013
ReviewDiagnosis of pneumonia in mechanically ventilated patients. What is the meaning of the CPIS?
Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in critically ill patients, especially in those being mechanically ventilated. Beside increased healthcare costs due to prolonged hospital stay, VAP is associated with a consistently high morbidity and mortality. Although pathomechanisms leading to VAP are well known, it remains challenging to diagnose VAP accurately and in a timely manner. ⋯ Several evidence based strategies have been described for the diagnosis of ventilator associated pneumonia, potentially leading to better or faster treatment and thereby influencing the outcome. Current diagnostic approaches and the value of the CPIS are therefore considered within this article. A bundle approach, regarding time management and several diagnostic pathways should be evaluated in further studies.
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Qualitative insights may demonstrate how combat medics (CM) deal with stressors and identify how resilience can potentially develop. Yet, qualitative research is scant in comparison to the many quantitative studies of health outcomes associated with military service. ⋯ An individual's commitment to country, military family and faith strengthens their resilience, and this can be used to inform future research efforts as well as current clinical practice.
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The results of prolonged and extensive procedures in the critically injured are poor, even in experienced hands. The operating theatre is a hostile and physiologically unfavourable environment for the severely injured patient. ⋯ The damage control concept places surgery as an integral part of the resuscitative process, rather than an end in itself, and recognises that outcomes after major trauma are determined by the physiological limits of the patient, rather than by efforts of anatomical restoration by the surgeon. All those involved in the care of wounded patients should be familiar with this concept and its surgical and logistical implications.
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The adoption of regional and epidural analgesia in UK military personnel injured in action during Op HERRICK increased from 2008, in line with structural and environmental developments in the UK medical treatment facility. Historically, there have been concerns that invasive analgesic techniques could carry an increased risk of infection, due to the mechanism of injury and the environmental conditions in which the injuries were sustained. Consequently, the epidural and continuous peripheral nerve blockade (CPNB) catheters that were inserted in UK military personnel during a 33-month period of Op HERRICK were clinically and microbiologically examined, after subsequent admission to the University Hospitals Birmingham (UHB) NHS Trust. ⋯ With the exception of the epidural (34%) and proximal sciatic (42%) catheters, these figures, in a military cohort characterised by significant injury scores, are consistent with those reported for civilian surgical patients. The results strongly support the expansion of regional analgesia during Op HERRICK from 2008 onwards. The outcomes suggest a possible translation into civilian major trauma practice.