Search results for "Intensive Care Medicine"
showing 10 items of 2228 documents
Optimising experimental research in respiratory diseases: an ERS statement
2018
Experimental models are critical for the understanding of lung health and disease and are indispensable for drug development. However, the pathogenetic and clinical relevance of the models is often unclear. Further, the use of animals in biomedical research is controversial from an ethical perspective.The objective of this task force was to issue a statement with research recommendations about lung disease models by facilitating in-depth discussions between respiratory scientists, and to provide an overview of the literature on the available models. Focus was put on their specific benefits and limitations. This will result in more efficient use of resources and greater reduction in the numb…
Untargeted Antifungal Treatment in the ICU: Changing Definitions and Labels Do Not Change the Evidence.
2018
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Lessons from uncertainty on antifungal treatment in ICU
2017
We read with great interest the Editorial from Moghnieh et al. on the EMPIRICUS trial and antifungal use in intensive care unit (ICU) (1). Authors described nicely the trial and some background evidence on untargeted antifungal treatment in non-neutropenic critically ill patients in ICU (2,3). However, we believe that some points may be further clarified. First, it may be useful to cite the study from Knitsch et al. among those evaluating empiric antifungal treatment in ICU (4). Knitsch et al. enrolled 252 critically ill patients with localized/generalized intra-abdominal infection either of community or of nosocomial origin requiring emergency surgery.
Nephrotoxicity in the setting of invasive fungal diseases
2008
Amphotericin B, a broad spectrum antifungal agent, is widely used despite significant adverse events including nephrotoxicity. Nephrotoxicity occurs frequently in patients receiving amphotericin B. Different definitions for nephrotoxicity are reviewed in the context of outcome in patients with invasive fungal diseases. In most publications, mortality was higher in patients experiencing nephrotoxicity and mean hospital length of stay was prolonged. As a consequence, the use of less nephrotoxic antifungal agents could improve treatment outcomes.
Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights
2017
Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategi…
Pooled analysis of safety for micafungin
2008
Micafungin (MICA) is an efficacious antifungal treatment for life-threatening fungal infections [1-4].
What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients?
2017
: Invasive fungal infections (IFIs) are associated with high morbidity and mortality in intensive care units. Candida species are the most important fungal pathogens and among the most frequent causes of infection in critically ill patients. Studies have evaluated the correlation between the onset of antifungal treatment and survival. However, definitive diagnosis of IFI is time-consuming in clinical practice. Antifungal prophylaxis and preemptive or empirical treatments are among therapeutic strategies to prevent or treat early fungal infections in selected patients. Recently, new evidence from randomized controlled trials and systematic reviews has been published. Moreover, new clinical p…
Anti-inflammatory and antioxidant effects of ranolazine on primary cultured astrocytes
2014
Because of its ability to block late INa [1], ranolazine is used as an antianginal agent for the treatment of chronic angina pectoris when angina is not adequately controlled by other agents [2]. Besides its cardiovascular effects, ranolazine improves different neuronal functions, and thus its use has been proposed for the treatment of pain and epileptic disorders [3,4]. Since astrocytes are involved in neuronal inflammatory processes, and autoimmune and neurodegenerative diseases [5], we have investigated the antiinflammatory and antioxidant effects of ranolazine in primary cultured astrocytes.
Poor Esophageal Motility: A Tailored Approach?
2014
New onset dysphagia following antireflux surgery is among the most undesirable side effects of an otherwise excellent therapy. While its cause is multifactorial, insufficient circular muscle strength of the esophageal body, not powerful enough to force the bolus through the distal neo-high pressure zone, can be a component of the pathophysiology. The relative merits of “tailoring” the degree of fundoplication based upon esophageal body motility and/or other clinical features have been debated for decades. Herein we discuss the rationale for a tailored approach, its pros and cons and review data published to date available to guide the clinician in individual patient decision-making.
Aortic stiffness in patients with early sepsis
2014
Acute and chronic systemic inflammatory conditions are associated with aortic stiffening. Carotid-femoral pulse wave velocity (PWV), a marker of aortic stiffness, increases in patients with inflammatory diseases and independently correlates to levels of C-reactive protein (CRP). The effects of massive inflammatory response in early sepsis on mechanical properties of the aorta have not been investigated. The objective of the current study was to prospectively assess aortic stiffness in patients with early severe sepsis and septic shock and relate it to inflammatory and haemodynamic variables and outcome.