PubMed Central (PMC3 - NLM DTD)
(2,081,148 recursos)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
162.
Pro/con debate: Antifungal prophylaxis is important to prevent fungal infection in patients with acute necrotizing pancreatitis receiving broad-spectrum antibiotics - Eggimann, Philippe; Jamdar, Saurabh; Siriwardena, Ajith K
When critically ill patients with pancreatitis develop infection of the pancreas, the ongoing management of such patients becomes difficult. Sufficient evidence supports the use of broad-spectrum antibiotic prophylaxis to prevent the development of bacterial infection. Since fungal infection is also a relatively common complication of severe pancreatitis particularly when broad-spectrum antibiotics are used it seems logical that fungal prophylaxis may be an important component of management. In this issue of Critical Care, two expert groups debate the merits of antifungal prophylaxis in patients with acute necrotizing pancreatitis who are receiving antibiotics.
165.
Evidence-based medicine: Classifying the evidence from clinical trials the need to consider other dimensions - Bellomo, Rinaldo; Bagshaw, Sean M
The current approach to assessing the quality of evidence obtained from clinical trials focuses on three dimensions: the quality of the design (with double-blinded randomised controlled trials representing the highest level of such design); the statistical power (beta) and the level of significance (alpha). While these aspects are important, we argue that other significant aspects of trial quality impinge upon the truthfulness of the findings: biological plausibility, reproducibility and generalisability. We present several recent studies in critical care medicine where the design, beta and alpha components of the study are seemingly satisfactory but where the aspects of biological plausibility, reproducibility...
166.
A comparison of decision-making by physicians and administrators in healthcare settings - Matheson, David S; Kissoon, Niranjan
Physicians and administrators are committed to the same goal of providing quality care at affordable costs. Their perceptions of each other and their resulting behaviors, however, may lead to conflict. We offer some insight into these perceptions and behaviors, and provide a framework to improve communication and to reduce misunderstanding.
168.
Predicting volume responsiveness in spontaneously breathing patients: still a challenging problem - Magder, S
The prediction of which patients respond to fluid infusion and which patients do not is an important issue in the intensive care setting. Assessment of this response by monitoring changes in some hemodynamic characteristics in relation to spontaneous breathing efforts would be very helpful for the management of the critically ill. This unfortunately remains a difficult clinical problem, as discussed in the previous issue of the journal. Technical factors and physiological factors limit the usefulness of current techniques.
169.
Bench-to-bedside review: Potential strategies to protect or reverse mitochondrial dysfunction in sepsis-induced organ failure - Protti, Alessandro; Singer, Mervyn
The pathogenesis of sepsis-induced multiple organ failure may crucially depend on the development of mitochondrial dysfunction and consequent cellular energetic failure. According to this hypothesis, interventions aimed at preventing or reversing mitochondrial damage may have major clinical relevance, although the timing of such interventions will be critical to both ensuring benefit and avoiding harm. Early correction of tissue hypoxia, strict control of glycaemia, and modulation of oxidative and nitrosative stress may afford protection during the initial, acute systemic inflammatory response. The regulated induction of a hypometabolic state resembling hibernation may protect the cells from dying once energy failure has developed,...
170.
Ethics roundtable debate: Patients and surrogates want 'everything done' what does 'everything' mean? - Doig, Christopher; Murray, Holt; Bellomo, Rinaldo; Kuiper, Michael; Costa, Rubens; Azoulay, Elie; Crippen, David
Highly complex and specialized care plans sometimes overwhelm the comprehension of patients and families. Many optimistic surrogates of critically ill patients err on the side of desiring that everything be done but with a nebulous idea of what 'everything' entails. Physicians must work closely to educate surrogates as to the benefits versus the risks of treatment. Our roundtable experts ponder the question of whether providers possess the authority to interpret unilaterally the nature of requests for everything.
171.
Recently published papers: pneumonia, hypothermia and the elderly - Bouch, Christopher; Williams, Gareth
Pneumonia (hospital-acquired and community-acquired) is commonly encountered in intensive care. Several papers recently published on this subject have shed more light on different aspects of this important topic. Hypothermia has been shown to improve post-arrest outcome, but how often do we use it? And finally, several papers have recently appeared in the journals related to the admission of the elderly to the critical care area and their outcome.
173.
Clinical review: Alternative vascular access techniques for continuous hemofiltration - DiCarlo, Joseph V; Auerbach, Scott R; Alexander, Steven R
Obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic, especially in the child or adult in multiple organ failure with edema and/or coagulopathy. Problems commonly encountered include obstruction of the femoral vein by the catheter, insertion difficulties, safety concerns when cannulating the subclavian vein in coagulopathy, and catheter and circuit occlusion due to disseminated intravascular coagulation. For access in infants we describe a technique utilizing two single-lumen thin-walled vascular sheaths. For infants and small children initial access to the vein may be difficult due to edema or poor perfusion. For this situation we describe the 'mini-introducer' technique...
175.
Antimicrobial resistance and patient outcomes: the hazards of adjustment - Schwaber, Mitchell J; Carmeli, Yehuda
Outcomes studies of infections with resistant bacteria often do not account appropriately for intermediate variables events in the causal pathway between the exposure and the outcome when controlling for confounders. We discuss how failure to distinguish between confounders and intermediate variables can bias the analysis, and we address methods of approaching this issue.
177.
Bench-to-bedside review: Endotoxin tolerance as a model of leukocyte reprogramming in sepsis - Cavaillon, Jean-Marc; Adib-Conquy, Minou
Endotoxin tolerance is defined as a reduced responsiveness to a lipopolysaccharide (LPS) challenge following a first encounter with endotoxin. Endotoxin tolerance protects against a lethal challenge of LPS and prevents infection and ischemia-reperfusion damage. Endotoxin tolerance is paralleled by a dramatic reduction of tumor necrosis factor (TNF) production and some other cytokines in response to LPS. Endotoxin tolerance involves the participation of macrophages and mediators, such as glucocorticoids, prostaglandins, IL-10, and transforming growth factor-?. Endotoxin tolerance is accompanied by the up-regulation of inhibitory molecules that down-regulate the Toll-like receptor (TLR)4-dependent signaling pathway. Cross-tolerance between LPS and other TLR specific ligands,...
178.
Organ donation after circulatory death: the forgotten donor? - Rady, Mohamed Y; Verheijde, Joseph L; McGregor, Joan
Donation after circulatory death (DCD) can be performed on neurologically intact donors who do not fulfill neurologic or brain death criteria before circulatory arrest. This commentary focuses on the most controversial donor-related issues anticipated from mandatory implementation of DCD for imminent or cardiac death in hospitals across the USA. We conducted a nonstructured review of selected publications and websites for data extraction and synthesis. The recommended 5 min of circulatory arrest does not universally fulfill the dead donor rule when applied to otherwise neurologically intact donors. Scientific evidence from extracorporeal perfusion in circulatory arrest suggests that the procurement process itself...
179.
Statins, bugs and prophylaxis: intriguing possibilities - Terblanche, Marius; Smith, Terry S; Adhikari, Neill KJ
Statin therapy may represent a potential prophylactic intervention in certain high-risk scenarios, for example in pandemic influenza and in those undergoing aggressive medical treatments. Emerging data indicate a potential prophylactic role in these high-risk groups.
161.
