Abstract：
:This article reviews principles in the rational use of antibiotics in sepsis and septic shock and presents evidence-based recommendations for optimal antibiotic therapy. Every patient with sepsis and septic shock must be evaluated at presentation before the initiation of antibiotic therapy. However, in most situations, an abridged initial assessment focusing on critical diagnostic and management planning elements is sufficient. Intravenous antibiotics should be administered as early as possible, and always within the first hour of recognizing severe sepsis and septic shock. Broad-spectrum antibiotics must be selected with one or more agents active against likely bacterial or fungal pathogens and with good penetration into the presumed source. Antimicrobial therapy should be reevaluated daily to optimize efficacy, prevent resistance, avoid toxicity, and minimize costs. Consider combination therapy in Pseudomonas infections, and combination empiric therapy in neutropenic patients. Combination therapy should be continued for no more than 3 to 5 days and deescalation should occur following availability of susceptibilities. The duration of antibiotic therapy typically is limited to 7 to 10 days; longer duration is considered if response is slow, if there is inadequate surgical source control, or in the case of immunologic deficiencies. Antimicrobial therapy should be stopped if infection is not considered the etiologic factor for a shock state.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Kumar Adoi
10.1016/j.ccc.2009.08.004subject
Has Abstractpub_date
2009-10-01 00:00:00pages
733-51, viiiissue
4eissn
0749-0704issn
1557-8232pii
S0749-0704(09)00069-4journal_volume
25pub_type
杂志文章,评审abstract：:Hemodynamic resuscitation for hemorrhagic shock should be directed toward optimizing oxygen delivery to the tissues. A combination of volume restoration and inotropic support usually is needed. This article identifies the basis and strategies necessary for accomplishing these goals. ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1993-10-01 00:00:00
abstract：:Although our understanding of molecular events in septic shock is growing exponentially, bedside management has changed only incrementally over the last 20 years. In pediatric and adult patients alike, treatment continues to be largely supportive. Morbidity and mortality, though gradually improving, continue to be hig...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70328-6
更新日期：1997-07-01 00:00:00
abstract：:The pathophysiology of the burn injury and treatment factors that influence burn depth are explained. Details of burn wound care, including indications for early excision, topical antimicrobials, and the most recent advances in skin substitutes, are described. Burn wound sepsis, the most common and serious complicatio...
journal_title：Critical care clinics
pub_type： 杂志文章
doi：
更新日期：1985-03-01 00:00:00
abstract：:An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.06.002
更新日期：2018-10-01 00:00:00
abstract：:Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specifi...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2010.06.009
更新日期：2010-10-01 00:00:00
abstract：:Providing nutritional support has become a standard component of managing critically ill patients. While many studies have documented that providing nutritional support can change nutritional outcomes (e.g., amino acid profile, weight gain, nitrogen balance), data are lacking that demonstrate that nutrition actually i...
journal_title：Critical care clinics
pub_type： 杂志文章,meta分析
doi：10.1016/s0749-0704(05)70009-9
更新日期：1998-07-01 00:00:00
abstract：:In summary, interventional techniques are well-established and offer safe and effective alternatives for management of patients in the intensive care unit or other setting. It is likely that the radiologist will become more involved in the management of ill children and adults. It is hoped that this will reduce the ne...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1994-04-01 00:00:00
abstract：:In July 2001, the United States Joint Commission on Accreditation of Health care Organizations adopted a new leadership standard that requires department heads in health care organizations to perform at least one Failure Mode and Effects Analysis (FMEA) every year. This proactive approach to error prevention has prove...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.07.005
更新日期：2005-01-01 00:00:00
abstract：:Laboratory testing is ubiquitous among hospitalized patients and is more common among patients in the intensive care unit (ICU). Despite its high cost and prevalence, there are few data to support the current practice of laboratory testing in most ICUs. Although testing offers considerable potential benefits, it is no...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2007.07.005
更新日期：2007-07-01 00:00:00
abstract：:Hypertension is a pervasive and growing health concern. The occurrence of hypertension due to systemic vasoconstriction in patients before, during, and after surgery is not uncommon and can have serious consequences with regard to outcomes. Careful evaluation prior to surgery to identify the underlying cause of hypert...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：2007-10-01 00:00:00
abstract：:Procalcitonin is a biomarker that is generally elevated in bacterial infections. This review describes a conceptual framework for biomarkers using lessons from the history of troponin, applies this framework to procalcitonin with a review of observational studies and randomized trials in and out of the intensive care ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2019.08.003
更新日期：2020-01-01 00:00:00
abstract：:As the geriatric population in the United States increases and better management of chronic diseases improves survival, more elderly will become critically ill and potentially require treatment in an intensive care unit (ICU). Dan Callahan has written, "... we will live longer lives, be better sustained by medical car...
journal_title：Critical care clinics
pub_type： 杂志文章
doi：10.1016/s0749-0704(03)00056-3
更新日期：2003-10-01 00:00:00
abstract：:Blunt thoracic trauma can result in significant morbidity in injured patients. Both chest wall and the intrathoracic visceral injuries can lead to life-threatening complications if not anticipated and treated. Pain control, aggressive pulmonary toilet, and mechanical ventilation when necessary are the mainstays of sup...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(03)00098-8
更新日期：2004-01-01 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：: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：: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：:Critically ill cancer patients have a higher incidence of acute kidney injury treated with renal replacement therapy than critically ill patients without cancer. Acute kidney injury may occur as a direct or indirect consequence of the cancer itself, its treatment, or associated complications. Several recent studies ha...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2009.09.002
更新日期：2010-01-01 00:00:00
abstract：:Sepsis is caused by a dysregulated host response to infection. Immune responses determine the characteristics of sepsis. The body's protection against infection involves danger signal surveillance and recognition from nonself, effector functions in response to sensing danger signals, homeostatic regulation, and genera...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2017.08.002
更新日期：2018-01-01 00:00:00
abstract：:Extracorporeal life support is a modified form of cardiopulmonary bypass. Experience in extracorporeal membrane oxygenation (ECMO) has come largely from the neonatal population. Most centers have transitioned the ECMO pumps from roller pumps to centrifugal technology. Modes of support include venovenous for respirator...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2017.06.005
更新日期：2017-10-01 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：:Access to critical care is rapidly growing in areas of the world where it was previously nonexistent and where infectious diseases often comprise the largest disease burden. Additionally, with crowding, mass migrations, and air travel, infectious diseases previously geographically confined are quickly spread across th...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2013.03.005
更新日期：2013-07-01 00:00:00
abstract：:Acute coronary syndrome is a major health problem affecting approximately 1.5 million individuals a year. Early diagnosis and appropriate evidence-based therapies improve clinical outcomes significantly. Current data suggest that an early invasive therapy may improve intermediate-term and long-term outcomes, particula...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2007.07.003
更新日期：2007-10-01 00:00:00
abstract：:Acute respiratory failure is common in critically ill children, who are at increased risk of respiratory embarrassment because of the developmental variations in the respiratory system. Although multiple etiologies exist, pneumonia and bronchiolitis are most common. Respiratory system monitoring has evolved, with the ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2012.12.004
更新日期：2013-04-01 00:00:00
abstract：:A substantial proportion of patients admitted to intensive care units (ICUs) are elderly patients. Based upon population growth, patient preference, and current physician practice, the number of elderly patients who receive critical care services is likely to increase substantially over the next 10 to 20 years. Numero...
journal_title：Critical care clinics
pub_type： 杂志文章
doi：10.1016/s0749-0704(03)00051-4
更新日期：2003-10-01 00:00:00
abstract：:The appropriate starting point for a history of neurocritical care is a matter of debate, and the organization of facts and conjectures about it must be somewhat arbitrary. Intensive care for neurosurgical patients dates back to the work of Walter Dandy at the Johns Hopkins Hospital in the 1930s; many consider his cre...
journal_title：Critical care clinics
pub_type： 历史文章,杂志文章
doi：10.1016/j.ccc.2008.12.004
更新日期：2009-01-01 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：:There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period. Mechanisms of hypoxemia include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonal...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-04-01 00:00:00
abstract：:Prolonged intubation and mechanical ventilation following cardiac surgery have been associated with increased hospital and intensive care unit length of stays; higher health care costs; and morbidity resulting from atelectasis, intrapulmonary shunting, and pneumonia. Early extubation was developed as a strategy in the...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2020.06.005
更新日期：2020-10-01 00:00:00
abstract：:Acute respiratory failure can be the result of a variety of clinical conditions, such as congestive heart failure, pneumonia, pulmonary embolism, exacerbation of obstructive lung diseases, and acute respiratory distress syndrome (ARDS). This article focuses on developments related to acute lung injury and ARDS and rev...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.05.010
更新日期：2004-10-01 00:00:00
abstract：:Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients are still significant. Cardiovascular disease accounts for much of the mortality in long-term survivors; screening before the transplant procedure and adequate control of hypertension should he...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1990-10-01 00:00:00
