24 Apr 10
Posted in Glycemic control at 1:00 by Laci
By M Hoekstra, M Vogelzang, E Verbitskiy and M Nijsten
Critical Care 2010, 14:404
In the recently published work of Juneja and colleagues the authors describe the excellent results of a computerized insulin dosing algorithm (Clarian GlucoStabilizer™). To prevent hypoglycemia, however, the authors note that frequent (that is, hourly) measurements are required. We believe that, with an adequate algorithm, the required level of glucose control can be reached without hourly glucose measurements.
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11 Apr 10
Posted in Arrhythmia at 5:12 by Laci
By S Goodman, Y Weiss and C Weissman
Curr Opin Crit Care 2008;14:549–554
Purpose of review
To explore recent findings on the treatment and outcome of cardiac arrhythmias and how they affect ICU activities.
Recent findings
The rate vs. rhythm control debate for the treatment of chronic atrial fibrillation continues. It is still unclear whether the postcardiac surgery inflammatory response contributes to the development of atrial fibrillation. In noncardiothoracic surgery/trauma patients hospitalized in an ICU, new-onset supraventricular arrhythmias are associated with markedly elevated mortality when compared with patients with a prior history of such arrhythmias and patients who do not develop arrhythmias. The onset of new supraventricular arrhythmias in such patients appears to be a manifestation of multiple system organ failure as it is closely associated with sepsis. Cardioversion of supraventricular arrhythmias with biphasic waveforms is being studied to determinewhether it is more effective than cardioversion with monophasic waveforms.
Summary
Supraventricular arrhythmias, especially atrial fibrillation, occur frequently in ICU patients. Intensivists not only treat atrial fibrillation itself but also its complications and the complications of the therapies used to prevent these complications. In ICUpatients, ventricular arrhythmias have ominous implications because they usually portend either a major cardiac or a systemic dysfunction or both.
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09 Apr 10
Posted in PA catheter at 2:19 by Laci
By S Greenberg, G Murphy and J Vender
Curr Opin Crit Care 2009;15:249–253
Purpose of review
The pulmonary artery catheter is one of the most scrutinized monitors used in intensive care today. Pulmonary artery catheter use is declining due to limited demonstrated beneficial outcomes and the advancement of less invasive monitoring. This study discusses the current use of the pulmonary artery catheter and problems associated with its use including inaccuracy of measurements and data interpretation, inappropriately applied therapeutic interventions, inappropriate delays in applying interventions, and inappropriate patient selection.
Recent findings
This overview presents current controversies surrounding the pulmonary artery catheter. It also discusses commonly used monitors and their lack of demonstrated benefits. In addition, data show that intensivists do not have sufficient knowledge to effectively use the pulmonary artery catheter. When utilized in a timely appropriate manner, pulmonary artery catheter monitoring may benefit a selected patient population.
Summary
In summary, the pulmonary artery catheter monitor continues to be used for intensive care patients. To date, no single monitor is associated with an abundance of clear outcome benefits. There are some clinical data showing that the pulmonary artery catheter may still be useful when applied to the right patient population using appropriately timed therapies
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03 Apr 10
Posted in Critical Care, Infection at 1:00 by Laci
By T Dellit, R Owens, J McGowan, D Gerding, R Weinstein, J Burke et al
Clinical Infectious Diseases 2007;44:159–177
This document presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. The multifaceted nature of antimicrobial stewardship has led to collaborative review and support of these recommendations by the following organizations: American Academy of Pediatrics, American Society of Health‐System Pharmacists, Infectious Diseases Society for Obstetrics and Gynecology, Pediatric Infectious Diseases Society, Society for Hospital Medicine, and Society of Infectious Diseases Pharmacists. The primary goal of antimicrobial stewardship is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms (such as Clostridium difficile), and the emergence of resistance. Thus, the appropriate use of antimicrobials is an essential part of patient safety and deserves careful oversight and guidance. Given the association between antimicrobial use and the selection of resistant pathogens, the frequency of inappropriate antimicrobial use is often used as a surrogate marker for the avoidable impact on antimicrobial resistance. The combination of effective antimicrobial stewardship with a comprehensive infection control program has been shown to limit the emergence and transmission of antimicrobial‐resistant bacteria. A secondary goal of antimicrobial stewardship is to reduce health care costs without adversely impacting quality of care.
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