High lactate concentrations on admission were an independent predictor of poor neurological recovery post-CA, but the time course was not related to outcome. Prolonged resuscitation, use of vasopressors, high PaO<sub>2</sub> and altered renal function were predictors of high lactate concentrations.
ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients.
Intensive care unit admissions are frequently limited by the availability of beds across Europe, particularly in the south and in the United Kingdom, yet 73% of intensivists still admit patients with no hope of survival. When treating patients with no hope of survival, 40% of intensivists will deliberately administer large doses of drugs until death ensues. There are interesting differences between what a physician actually does and what he or she believes should be done with regard to various ethical questions. Important differences in attitudes also exist between European countries.
"Estimating Left Ventricular Filling Pressure in Patients Receiving Positive End-Expiratory Pressure: Reply." American Review of Respiratory Disease, 144(4), pp. 993–994
Sepsis, defined as infection plus some degree of organ dysfunction, is still associated with high mortality and morbidity rates. Management focuses on three key areas: infection control, hemodynamic stabilization and organ support, and modulation of the sepsis response. Areas covered: This review will not cover infection control. Hemodynamic stabilization essentially involves the use of adequate fluid resuscitation and vasopressors. Fluid and vasopressor choices and targets are discussed, and the need to adapt these to the individual patient is stressed. No drugs are currently available that modulate the sepsis response, with the possible exception of corticosteroids in the most severe cases. The place of vasopressin is not well defined. Some of the immunomodulatory agents currently in development are briefly discussed. Expert opinion: Management of the patient with sepsis remains a challenge and needs to be personalized. The search for new immunomodulatory drugs continues and will be facilitated by better characterization of patients using modern 'omics' technology and complex analysis of the large quantities of clinical data increasingly available.
info:eu-repo/semantics/published
