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A study was conducted to evaluate the benefits and risks associated with the use of corticosteroids as a form of treatment for severe and septic shock among adults. Results indicated that there is no clear indication of benefit in reduction of mortality after use of such medicines, however, of late, low-dosage has been recommended for more beneficial results.

Objective: To compare the FloTrac/VigileoTM cardiac output (COFT/V) and the MostCare®/PRAM cardiac output (COMC/P) versus transthoracic echocardiographic cardiac output estimation (reference method; COECHO). Design: Prospective observational study. Setting: Single center, Cardio-Thoracic and Vascular Surgery/Intensive Care Unit. Participants: Patients undergoing elective vascular surgery. Interventions: Cardiac output measurement with two pulse contour methods: the FloTrac/VigileoTM and the MostCare®/PRAM before (T1) and after (T2) fluid loading versus echocardiography (reference method). Measurements and Main Results: One hundred fifty-six CO measurements were performed in 26 patients. The data showed poor agreement between COECHO and COFT/V: r2 = 0.29 (T1) and 0.27 (T2); bias −0.37 (T1) and −0.40 (T2) L/min; limits of agreement from −3.10 to 2.42 (T1) and from −3.0 to 2.2 (T2) L/min. The percentage error was 51.7% (T1) and 49.3% (T2). Conversely, COMC/P resulted in agreement with echocardiography: r2 = 0.76 (T1) and 0.80 (T2); bias −0.01 (T1) and −0.06 (T2) L/min; limits of agreement from −1.13 to 1.11 (T1) and from −0.90 to 0.80 (T2) L/min, with a PE of 22.4% (T1) and of 17.0% (T2). Conclusions: In patients undergoing vascular surgery, the FloTrac/VigileoTM did not demonstrate that it was a reliable system for CO monitoring when compared with echocardiography-derived CO. However, MostCare®/PRAM was shown to estimate CO with a good level of agreement with echocardiographic measures. [Copyright &y& Elsevier]

Competing Interests: The authors declare no conflict of interest.

Patients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome. A deep understanding of antibacterial agents pharmacology in the critically ill is essential in order to treat severe infections; moreover, it is necessary to know routes of administration and composition of artificial nutrition solutions. The aim of this review is to define main and specific aspects of antibiotic therapy and nutritional support in cardiac critical care patients in light of recent literature data.