Abstract:
:Nosocomial diarrheas are an important problem in hospitals, and in critical care units in particular. Hospital-acquired diarrhea may be on an infectious or noninfectious basis. Common noninfectious causes of nosocomial diarrhea include medication-induced changes in the fecal flora or changes secondary to enteral hyperalimenation. Infectious causes of nosocomial diarrhea are due to enteric pathogens in outbreak situations and virtually all of the causes are due to Clostridium difficile. C. difficile is a resident of the human colon and does not cause disease if its toxins are not elaborated. Chemotherapeutic agents, and more commonly, antibiotics, induce the elaboration of toxin A and B from C. difficile in the distal gastrointestinal tract. The spectrum of disease of C. difficile in hospitalized patients includes asymptomatic carriage to mild watery diarrhea, fulminant and severe diarrhea, and pseudomembranous enterocolitis. The treatment of C. difficile diarrhea is usually with oral metronidazole or vancomycin, and C. difficile colitis is treated with intravenous metronidazole. Infection control measures are necessary to prevent the spread of this sporforming organism within the institution since it is capable of surviving in the hospital environment for prolonged periods.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Cunha BAdoi
10.1016/s0749-0704(05)70398-5subject
Has Abstractpub_date
1998-04-01 00:00:00pages
329-38issue
2eissn
0749-0704issn
1557-8232pii
S0749-0704(05)70398-5journal_volume
14pub_type
杂志文章,评审abstract::Venous thromboembolic disease is a very common complication in the ICU. This article reviews incidence, prevention, and therapy related to venous thromboembolism, including both deep venous thrombosis and pulmonary embolism. Special diagnostic and treatment considerations in the ICU setting are highlighted. The increa...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2005.05.004
更新日期:2005-07-01 00:00:00
abstract::This article summarizes the biomechanical relationship of the spinal column to load stresses with respect to column failure, and the resulting associated central nervous system injury. In addition, it presents pertinent animal research, which has focused onto the development standardized animal spinal cord injury mode...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-07-01 00:00:00
abstract::The known metabolic abnormalities and nutritional requirements of the brain injury, spinal cord injury, and acute stroke patient have been presented. Further investigations are required in all these conditions to identify specific nutritional requirements and metabolic abnormalities. The specific role of nutritional s...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-01-01 00:00:00
abstract::The thyrotoxic patient offers a considerable challenge to the critical care physician because the "obvious" diagnosis often will be a cardiac (or other nonthyroidal) problem, but the "correct" diagnosis will be an endocrinologic one. The importance of considering the diagnosis of thyrotoxicosis in any patient with tac...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00
abstract::Measuring cardiac output without knowledge of the oxygen extraction by the tissues is of limited value. Instead of calculating oxygen consumption and oxygen delivery, a diagram relating cardiac index to the oxygen extraction ratio is proposed to interpret hemodynamic data at the bedside. This diagram is particularly h...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70288-8
更新日期:1996-10-01 00:00:00
abstract::The most important adaptive responses from a physiological stance involved the cardiovascular system, consisting in particular of elevation of the cardiac output and its redistribution to favor the coronary and cerebral circulations, at the expense of the splanchnic vascular beds. The evidence regarding these physiolo...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2004.01.001
更新日期:2004-04-01 00:00:00
abstract::The years that have passed since the introduction of the pulmonary artery catheter have been marked by radical changes in the practice of general and critical care medicine. There has been an increase in the application of physiologic principles to the management of shock states, myocardial infarction, and respiratory...
journal_title:Critical care clinics
pub_type: 历史文章,杂志文章
doi:10.1016/s0749-0704(05)70278-5
更新日期:1996-10-01 00:00:00
abstract::The pregnant patient with normal cardiac function can accommodate many significant alterations in the cardiovascular system without difficulty. Pregnancy in a patient with significant cardiac disease, however, can be extremely hazardous, resulting in decompensation and even death. these conditions account for up to 30...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1991-10-01 00:00:00
abstract::Assessment of oxygenation is an integral part of monitoring critically ill patients. Current available modalities including pulse oximetry, transcutaneous and transconjunctival oxygen measurements are reviewed. In addition, future modalities to assess oxygen delivery and utilization at the level of the intact end-orga...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-07-01 00:00:00
abstract::Serotonin syndrome is characterized by varied degrees of cognitive, autonomic, and neuromuscular dysfunction and can only be produced by drug therapy that increases central nervous system serotonin neurotransmission. Information gained from a retrospective review of 127 cases of serotonin syndrome is presented. It is ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70368-7
更新日期:1997-10-01 00:00:00
abstract::This article argues that dopamine infused in low doses has not been shown to avert the onset of or ameliorate the course of acute renal failure in critically ill patients. The inotropic and diuretic effects of dopamine are discussed, and its adverse effects are described. An attempt is made to offer an evidence-based ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70272-4
更新日期:1996-07-01 00:00:00
abstract::The patient with advanced cirrhosis presents unique challenges to the critical care physician, in great measure because of the protean functions attributable to the liver and the multiplicity of derangements that may occur. Portal hypertension, once it develops, is the source of potentially devastating complications t...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-04-01 00:00:00
abstract::The proliferation of methicillin-resistant Staphylococcus aureus (MRSA) and the severity of nosocomial critical care infections necessitate the development of viable alternative therapies. An increase in the tolerance of MRSA to the activity of vancomycin and to the associated suboptimal therapeutic measures is of par...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2007.12.010
更新日期:2008-04-01 00:00:00
abstract::The consequences of acute and chronic drug abuse pose significant problems for physicians managing the trauma victim in the resuscitative, perioperative, intensive care, and hospitalization periods. Substance abuse, whether acute or chronic, modifies the physiologic response to injury and to resuscitative and operativ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::Acute renal failure continues to be a common occurrence in critically ill cancer patients. It frequently results from a combination of risk factors, which include the following: hemodynamic alterations associated with renal ischemia; exposure to nephrotoxic drugs; urinary tract obstruction; and specific abnormalities ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-01-01 00:00:00
abstract::The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The mai...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-01-01 00:00:00
abstract::Decisions to admit and discharge patients to and from the intensive care unit (ICU) when resources are scarce should be made according to the triage principle--that is, resources should be allocated based on the patient's ability to benefit from critical care. The ICU organizational structure and the constraints on de...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1993-07-01 00:00:00
abstract::The availability, portability, safety, and other features of ultrasound have ushered this relatively new imaging modality into the everyday clinical practice of multiple disciplines. Features unique to ultrasound lend this imaging modality the opportunity for extensive use in the ICU. A review of its uses in this capa...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70097-x
更新日期:2000-01-01 00:00:00
abstract::Hypocalcemia and hypophosphatemia have recently been recognized as common metabolic complications in acutely ill patients. The diagnostic and therapeutic approaches to these abnormalities are described in this article. ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-10-01 00:00:00
abstract::Infectious complications are common occurrences in end-stage liver disease (ESLD). Frequent infections precipitate decompensation of liver disease leading to acute or chronic liver failure, organ dysfunction, de-listing from transplant, and major morbidity and mortality. The spectrum of microorganisms has shifted with...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2016.03.006
更新日期:2016-07-01 00:00:00
abstract::This article provides an overview of some of the current issues involved in sedation and anxiolysis in the intensive care unit. The problems involved in trying to monitor sedation levels are discussed, as are some of the newer options available for physiologic monitoring of the central nervous system. The problem of a...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70043-9
更新日期:1999-01-01 00:00:00
abstract::Vasodilators that affect the pulmonary vasculature are appealing adjuncts in many cardiopulmonary conditions that require mechanical ventilation such as ARDS, COPD, PPHN, and cardiothoracic surgery. The adverse systemic effects of parenteral PGE1 and parenteral prostacyclin limit their usefulness in critically ill pat...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70023-3
更新日期:1998-10-01 00:00:00
abstract::Positive-pressure ventilation may improve gas exchange, decrease the work-cost of breathing, and rest respiratory muscles, but it also will alter cardiac output and may modify blood flow distribution. Ventilation may induce these hemodynamic changes by altering systemic venous return to the RV (RV preload), pulmonary ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1990-07-01 00:00:00
abstract::Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of t...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1992-07-01 00:00:00
abstract::Summarizing the mission of the ICU, the institution directive board and the unit director must generate a structure, proceedings criteria, management, and analysis of results capable of providing satisfactory care. Furthermore, they must take into account each organizational aspect that is necessary to offer an approp...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2006.04.002
更新日期:2006-07-01 00:00:00
abstract::Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrori...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2013.03.015
更新日期:2013-07-01 00:00:00
abstract::Ethical issues that arise in the care of pregnant women are challenging to physicians, especially in critical care situations. By familiarizing themselves with the concepts of medical ethics in obstetrics, physicians will become more capable of approaching complex ethical situations with a clear and structured framewo...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2015.08.007
更新日期:2016-01-01 00:00:00
abstract::The overlap syndrome defines the relationship between obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and is a commonly noted but poorly studied disorder. Individuals who have the overlap syndrome have been recognized to have greater risk for pulmonary hypertension, right heart failure,...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2008.02.005
更新日期:2008-07-01 00:00:00
abstract::This article reviews two important innovations in echocardiography resulting from the recent advances in the capabilities of microprocessors. The first, automatic endocardial border detection, has been implemented on computers contained entirely within echocardiograph machines and is gaining wide clinical use. The sec...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70256-6
更新日期:1996-04-01 00:00:00
abstract::Given time, the brain can tolerate extraordinarily severe hyponatremia, but it does not take well to sudden changes; both rapid onset and rapid correction of hyponatremia can be injurious. Emergency treatment of hyponatremia should be reserved for the patient who has not had time to fully adapt to the disturbance. Whe...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00