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The 2024 European Society of Intensive Care Medicine clinical practice guideline provide clinicians with evidence-based recommendations on intravenous fluid in critically ill adults across a range of common conditions. These guidelines aim to improve the practices of fluid therapy by adopting a global perspective that considers both clinical efficacy and resource utilization in diverse healthcare settings. The guidelines address three key questions: (1) albumin versus crystalloids, (2) balanced crystalloids versus isotonic saline, and (3) small-volume hypertonic solutions versus isotonic crystalloids.
View Article and Find Full Text PDFNebulized aminoglycosides for ventilator-associated pneumonia: Methodological considerations and lessons from experimental studies.
J Intensive Med
January 2025
Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
Aminoglycosides are concentration-dependent antibiotics exerting a bactericidal effect when concentrations at the site of infection are equal to or greater than 5 times the minimum inhibitory concentrations (MIC). When administered intravenously, they exhibit poor lung penetration and high systemic renal and ototoxicity, imposing to restrict their administration to 5 days. Experimental studies conducted in anesthetized and mechanically ventilated sheep and pigs provide evidence that high doses of nebulized aminoglycosides induce a rapid and potent bacterial killing in the infected lung parenchyma.
View Article and Find Full Text PDFReport of a Rare Case of Acute Abdominal Pain Post-partum: Spontaneous Ureteral Rupture.
Cureus
December 2024
Radiology, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR.
Spontaneous ureteral rupture is a rare cause of acute abdominal pain, particularly unusual during pregnancy or the post-partum period. While pregnancy-related changes like ureteral compression and dilation may play a role, no definitive mechanisms have been established. Clinicians should suspect ureteric injury in post-partum patients with free pelvic fluid.
View Article and Find Full Text PDFKlebsiella liver phlegmon mimicking a solid liver tumour.
Australas J Ultrasound Med
February 2025
Te Whatu Ora Southern, New Zealand 201 Great King Street, Central Dunedin Dunedin 9016 New Zealand.
Introduction: This case examines the sonographic and clinical challenge of diagnosing a pyogenic liver abscess with systemic metastatic infection.
Case Description: The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed.
Continuous risk monitoring and management of heart failure: Rationale and design of the ALLEVIATE-HF trial.
Eur J Heart Fail
January 2025
Medical University of South Carolina, Charleston, SC, USA.
Aims: Early identification and management of worsening heart failure (HF) is necessary to prevent disease progression and hospitalizations. The ALLEVIATE-HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) trial is a prospective, randomized, controlled, double-blind, multicentre trial that aims to assess the safety and efficacy of using the Reveal LINQ™ insertable cardiac monitor (ICM) in patients with HF to continuously monitor and evaluate HF risk status and guide timely interventions.
Methods: The ICM algorithm uses parameters derived from electrocardiogram (atrial fibrillation [AF], ventricular rate during AF, heart rate variability, and night heart rate), three-axis accelerometer (patient activity duration), and subcutaneous bioimpedance (fluid volume, respiration rate).
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