tailieunhanh - Báo cáo y học: "Is routine autopsy in the intensive care unit viable"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Is routine autopsy in the intensive care unit viable? | De Vlieger et al. Critical Care 2010 14 433 http content 14 4 433 CRITICAL CARE LETTER L_ Is routine autopsy in the intensive care unit viable Authors response Greet Yvonne Agnes De Vlieger Elien Marie Jeanne Lia Mahieu and Wouter Meersseman See related letter by Girbes and Zijlstra http content 14 3 425 and research by De Vlieger etal. http content 14 2 221 In the previous issue of Critical Care we read with interest the reaction of Girbes and Zijlstra 1 to our article on the role of autopsy in critically ill patients 2 . The authors believe that the declining autopsy rate is acceptable since current medicine is based on guidelines. However guidelines can be driven by findings in large series of autopsies. Candida pneumonia occurs rarely in patients in whom Candida species are isolated in respiratory specimens this argues against treating mechanically ventilated patients with antifungal drugs solely on the basis of a positive respiratory culture 3 . The recently published guidelines of the Infectious Diseases Society of America are also against such a practice 4 . We are convinced that the sensitivity and specificity of autopsy decline because of a lack of routine. Only pathologists who frequently perform autopsies are able to reveal rare pathologies. Good sensitivities and specificities of a test can be achieved only with a large sample size. Moreover the autopsies should be performed in the presence of the treating intensivist in order to improve the yield of the autopsy. Innovative techniques also arise and might improve diagnostic performance for example molecular analysis in sudden death 5 . Finally we believe that autopsy is not always a nonrandom sample from a small selected population. Roosen and colleagues 6 found an autopsy rate of 93 in the medical intensive care unit. Some firm conclusions were drawn for example fungal pneumonia is among the most frequently missed diagnoses in a medical intensive care unit 6 .