ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Infections acquired in the ICU have great consequences in critically ill patients. Most recent studies have shown that at least nosocomial bloodstream infections and nosocomial pneumonia directly contribute to lengthening ICU stay and weigh heavily on hospital costs. Moreover, the risk of death is increased two- to fourfold by the development of nosocomial infections in patients with poor underlying medical status. This review summarizes the results of the most recent studies that have evaluated the direct impact of nosocomial infections on the outcome of severely ill patients.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Intensive care units are high-risk areas for endemic and epidemic nosocomial infections. Although epidemics in the ICU represent only a small proportion of all nosocomial infections, they provide a meaningful tool to define modes of transmission, common sources, or reservoirs associated with specific infections. This article reviews the recent literature about outbreaks of nosocomial infections in the ICU, highlights investigational methods to determine modes of transmission, and describes some intervention methods to stop epidemics in the ICU.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Intravascular catheters have become indispensable and essential in the care of critically ill patients. However, the morbidity and mortality that result from vascular catheter-related infections and the high cost of managing such complications may offset the benefits derived from these devices. Several measures have been used to successfully prevent vascular catheter-related infection. These measures include the placement and maintenance of vascular catheters by a skilled infusion therapy team, the use of maximal sterile barriers during catheter insertion, the application of such topical disinfectants as chlorhexidine, the use of silver-impregnated subcutaneous cuffs (for the short-term use of central venous catheters), the practice of flushing catheters with a combination of antimicrobial and antithrombotic agents, the new hub model, and the antimicrobial coating of catheters with antiseptic (chlorhexidine and silver sulfadiazine) or antibiotic agents (minocycline and rifampin).

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Nosocomial sinusitis is a frequent but underdiagnosed complication of ICU care. Nasal intubation is thought to play a major role in pathogenesis, but the lack of sinus ventilation and pooling and stagnation of fluid in the sinuses of patients with depressed mental status who remain in the supine position may also contribute to the pathogenesis of this infection. Clinical manifestations of infection may be minimal. They include purulent nasal discharge and fever without an obvious source. Most cases of nosocomial sinusitis are caused byStaphylococcus aureus, Pseudomonas aeruginosa, and other gram-negative bacilli. Diagnosis is made by computed tomography scan of the sinuses and puncture and aspiration of fluid for culture from maxillary sinuses with radiographic evidence of sinusitis. Treatment includes removal of nasal tubes, application of topical decongestants to the nasal mucosa, and administration of antibiotics based on culture and susceptibility tests done on fluid aspirated from the involved sinus.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The transmural migration of bacteria, called translocation, has been demonstrated repeatedly in recent years. It was postulated that translocation was the active link between critical illness and late development of the multiple organ dysfunction syndrome, the gut being an occult reservoir of bacteria. Numerous experimental studies were conducted during the last decade in order to confirm this hypothesis. Even though proof of translocation has accumulated in experimental and clinical studies, the clinical importance of translocation still needs to be demonstrated. Indeed, translocating bacteria have been isolated in critically ill and trauma patients, with a particularly high incidence when there is gut obstruction. However, the generalization of this localized infectious process to the systemic circulation has not yet been proven. Clearance of circulating bacteria by the reticuloendothelial system of the gut and liver is probably sufficient to neutralize the infection. Thus, the postulated link between translocation and multiple organ failure is not yet established with certainty.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Widely used monitoring and imaging methods, the scarcity of objective assessments of the utility and reliability of many traditional physical signs, and the fast pace and time constraints of the critical care environment may have contributed to a neglect of some of the cardiovascular history taking and physical examination skills in this setting. Nevertheless, such low-technology skills remain very helpful in collecting a large part of the database on which patient treatment rests, and in establishing empathy and support with the patient and his or her relatives. This paper describes clinical methods applicable to the cardiovascular treatment of the critically ill patient, particularly for purposes of initial screening and to establish the rationale and priorities for further action.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Critical care physicians are often asked to assess and treat patients who are about to have major surgery and who have associated medical problems that place them at higher risk of morbidity and mortality (high-risk surgical patients). A major challenge facing physicians is the clinical and laboratory screening to identify these patients, selection and provision of appropriate physiologic assessment, and the identification of therapy that is beneficial and given to the correct physiologic goals. This review focuses on the development of our current practice and the areas where new knowledge mandates a change in approach.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID