MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Critical Care' source. Mon, 06 Feb 2012 10:52:22 +0100 http://www.medworm.com/index.php?rid=5663405&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F409 We read with great interest the recent study by Lobo and colleagues stating that fluid restriction during optimization of oxygen delivery (DO2) using dobutamine improves patient outcome after major surgery. Previous studies have shown that haemodynamic optimization using either an individualized goal-directed fluid substitution or inotrope to maximize DO2 reduces postoperative morbidity and hospital length of stay. Although the study brings important new insights, we believe however that some limits should be pointed. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5663405 Mon, 06 Feb 2012 05:00:00 +0100 5663405 http://www.medworm.com/index.php?rid=5654905&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR20 IntroductionThe Molecular Adsorbent Recycling System (MARS) is used to treat patients with liver failure. Observational data suggest that citrate anticoagulation during MARS is feasible. Comparative studies on the optimal anticoagulation regimen during MARS are lacking. The aim of the current study was to evaluate two heparin-free anticoagulation regimens. Methods: We performed a prospective randomized open-label crossover study of regional citrate anticoagulation against no anticoagulation. Ten patients (age 55 +/- 11 years) with liver failure undergoing MARS treatment were included. The primary endpoint was completion of MARS sessions. Secondary endpoints included treatment efficacy and safety. Longevity of MARS treatment was plotted as a Kaplan-Meier estimate. Fisher's exact test was us... Critical Care journals http://www.medworm.com/rss/comments.php?id=5654905 Fri, 03 Feb 2012 05:00:00 +0100 5654905 http://www.medworm.com/index.php?rid=5654906&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR19 Conclusions: In this in vivo ovine model, both recipient and blood product factors contributed to the development of TRALI. Sick (LPS infused) sheep rather than healthy (saline infused) sheep predominantly developed TRALI when transfused with supernatant from stored but not fresh PRBC. "Stored PRBC" induced a more severe injury than "stored PLT" and had a different storage lesion profile, suggesting that these outcomes may be associated with storage lesion factors unique to each blood product type. Therefore, the transfusion of fresh rather than stored PRBC may minimise the risk of TRALI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5654906 Wed, 01 Feb 2012 05:00:00 +0100 5654906 http://www.medworm.com/index.php?rid=5654907&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F106 There is increasing evidence that hemodynamic optimization by fluid loading, particularly when performed in the early phase of surgery, is beneficial in high-risk surgery patients: it leads to a reduction in postoperative complications and even to improved long-term outcome. However, it is also true that goal- directed strategies of fluid optimization focusing on cardiac output optimization have not been applied in the clinical routine of many institutions. Reasons are manifold: disbelief in the level of evidence and on the accuracy and practicability of the required monitoring systems, and economics. The FOCCUS trial examined perioperative fluid optimization with a very basic approach: a standardized volume load with 25 ml/kg crystalloids over 6 hours immediately prior to scheduled surger... Critical Care journals http://www.medworm.com/rss/comments.php?id=5654907 Tue, 31 Jan 2012 05:00:00 +0100 5654907 http://www.medworm.com/index.php?rid=5642536&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR18 IntroductionThe renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but experiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the adrenergic balance is modified. Methods: 60 females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to control group and received only the conventional anesthetic drugs and 20 ml/kg of lactated Ringer's over 30 mins. The others were also given an infusion of 50 ug/kg/min of esmolol (beta1-receptor blocker) or 0.01 ug/kg/min of phenylephrine (alpha1-adrenergic agonist) over 3 hours. The distribution and elimination of infused fluid was studied by volume kinetic analysis based on urinary excretion and blood hemoglobin level. Results: Both drug... Critical Care journals http://www.medworm.com/rss/comments.php?id=5642536 Mon, 30 Jan 2012 05:00:00 +0100 5642536 http://www.medworm.com/index.php?rid=5642535&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F408 I read with great interest the article by Morel et al. [1], suggesting that acute changes in the arterial partial pressure of carbon dioxide (PaCO2) can affect the venous-arterial difference in carbon dioxide tension ([increment]CO2). Ten ventilated and hemodynamically stable patients were included after elective cardiac surgery. Hypocapnia was induced by increasing of respiratory rate. The authors found that a decrease of PaCO2 was associated with a significant increase in [increment]CO2. This was explained by the fact that acute hypocapnia resulted in systemic vasoconstriction, thus decreasing the elimination of the total CO2 produced by the peripheral tissues, and therefore increased the gap. However, as all patients were monitored with a pulmonary artery catheter (PAC), the authors sho... Critical Care journals http://www.medworm.com/rss/comments.php?id=5642535 Mon, 30 Jan 2012 05:00:00 +0100 5642535 http://www.medworm.com/index.php?rid=5633983&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR15 IntroductionWe sought to determine the effect of nutritional support and insulin infusion therapy on serum and brain glucose levels and cerebral metabolic crisis after aneurysmal subarachnoid hemorrhage (SAH). Methods: Retrospective observational cohort study of fifty mechanically ventilated poor-grade (Hunt-Hess 4 or 5) aneurysmal SAH patients who underwent brain microdialysis monitoring for an average of 109 hours. Enteral nutrition was started within 72 hours of admission whenever feasible. Intensive insulin therapy was used to maintain serum glucose levels between 5.5 and 7.8 mmol/l. Serum glucose, insulin, and caloric intake from enteral tube feeds, dextrose, and propofol were recorded hourly. Cerebral metabolic distress was defined as a lactate to pyruvate ratio (LPR) >40. Time-serie... Critical Care journals http://www.medworm.com/rss/comments.php?id=5633983 Wed, 25 Jan 2012 05:00:00 +0100 5633983 http://www.medworm.com/index.php?rid=5633982&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR16 IntroductionOne of the therapeutic essentials in severe sepsis and septic shock is an adequate fluid replacement to restore and maintain circulating plasma volume, improve organ perfusion and nutritive microcirculatory flow. The type of solution to be used as fluid replacement remains discussed. The aim of the study was to evaluate the effects of clinically used fluid replacement solutions on renal function and inflammatory response. Methods: 23 anesthetized and ventilated female German Landrace pigs were investigated over 19 hours using a two-hit model that combined hemorrhagic and septic shock. The septic shock was induced using an Escherichia coli laden clot placed into the abdominal cavity. Infusions of 6% hydroxyethylstarch 130/0.42 in acetate (6% HES 130), 4% gelatin in acetate (4% g... Critical Care journals http://www.medworm.com/rss/comments.php?id=5633982 Wed, 25 Jan 2012 05:00:00 +0100 5633982 http://www.medworm.com/index.php?rid=5633981&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR17 Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5633981 Wed, 25 Jan 2012 05:00:00 +0100 5633981 http://www.medworm.com/index.php?rid=5633980&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F302 Resuscitation of septic patients by means of one or more fluid boluses is recommended by guidelines from multiple relevant organizations and as a component of surviving sepsis campaigns. The technique is considered a key and life-saving intervention during the initial treatment of severe sepsis in children and adults. Such recommendations, however, are only based on expert opinion and lack adequate experimental or controlled human evidence. Despite these limitations, fluid bolus therapy (20 to 40 ml/kg) is widely practiced and is currently considered a cornerstone of the management of sepsis. In this pointof-view critique, we will argue that such therapy has weak physiological support, has limited experimental support, and is at odds with emerging observational data in several subgroups of... Critical Care journals http://www.medworm.com/rss/comments.php?id=5633980 Wed, 25 Jan 2012 05:00:00 +0100 5633980 http://www.medworm.com/index.php?rid=5633979&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F407 Normal intravenous immunoglobulin (IVIg) preparations are potentially promising drugs for the adjunctive treatment of sepsis as the pool of IgG antibodies neutralizes a wide array of pathogens plus their virulence factors and in addition possesses broad anti-inflammatory and immunomodulating activities. However, several high quality clinical studies have failed to show an effect of IVIg therapy on survival of sepsis patients. The reason behind this lack of success could be that the wrong immunoglobulin preparations have been used so far. We review evidence from experimental sepsis studies proving that licensed IVIg with additionally enhanced antigen-binding polyspecificity have significant beneficial effects in all sepsis models used. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5633979 Wed, 25 Jan 2012 05:00:00 +0100 5633979 http://www.medworm.com/index.php?rid=5633978&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F406 In our retrospective observational study, carperitide had higher improvement rate of functional class, though some reports have been against the use of nesiritide in acute heart failure patients. Also, the use of carperitide was not associated with death or heart failure admission after adjustment. Carperitide compares favorably to nesiritide in several ways; it has a shorter half-life, does not mandate bolus infusion, and used mostly as a single agent. We surmise that these unique pharmacological profiles may be part of the reasons for the difference in outcomes and the use of carperitide should be judiciously evaluated in prospective trials.Key words: carperitide, nesiritide, acute heart failure (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5633978 Wed, 25 Jan 2012 05:00:00 +0100 5633978 http://www.medworm.com/index.php?rid=5623897&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR14 Conclusions: The improvements in renal function suggest alkaline phosphatase is a promising new treatment for patients with severe sepsis or septic shock with AKI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5623897 Mon, 23 Jan 2012 05:00:00 +0100 5623897 http://www.medworm.com/index.php?rid=5623896&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F405 In Critical Care, Mirela Bojan and colleagues recently reported their experience with early initiation of high-frequency oscillatory ventilation (HFOV) in pediatric cardiac surgery that demonstrated shorter mechanical ventilation times and intensive care unit stays. We submit the utility of HFOV is not limited to the pediatric population and discuss the use of HFOV in an adult patient undergoing aortic valve replacement. For our patient, HFOV allowed separation from cardiopulmonary bypass by improving oxygenation without affecting hemodynamics. The role of HFOV as a rescue tool after cardiopulmonary bypass to improved oxygenation for patients with refractory hypoxia needs further exploration. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5623896 Mon, 23 Jan 2012 05:00:00 +0100 5623896 http://www.medworm.com/index.php?rid=5615769&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR12 Conclusions: Persistently abnormal CBC responses are associated with a higher mortality following trauma. This is the first report noting that a failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5615769 Fri, 20 Jan 2012 05:00:00 +0100 5615769 http://www.medworm.com/index.php?rid=5615768&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR13 Conclusions: The population-based incidence of AKI treated with RRT was 19.2 per 100000 in Finland and 6.8% of all general ICU patients. The hospital and six-month mortality rates were lower than previ-ously reported for ICU-treated RRT patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5615768 Fri, 20 Jan 2012 05:00:00 +0100 5615768 http://www.medworm.com/index.php?rid=5615772&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR11 IntroductionAlthough the nonthyroidal illness syndrome (NTIS) is considered to be associated with adverse outcome in ICU patients, the performance of thyroid hormones to predict clinical outcome in ICU patients is unimpressive. The study was conducted to assess the prognostic value of the complete thyroid indicators (FT3, TT3, FT4, TT4, TSH and rT3) in unselected ICU patients. Methods: 480 consecutive patients without known thyroid diseases were screened for eligibility and followed up during the ICU stay. We collected each patient's baseline characteristics including the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, thyroid hormones levels, N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). The primary outcome was ICU mortality. Poten... Critical Care journals http://www.medworm.com/rss/comments.php?id=5615772 Thu, 19 Jan 2012 05:00:00 +0100 5615772 http://www.medworm.com/index.php?rid=5615771&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F202 You are responsible for a large medical surgical ICU. Your hospital administration has been very focused on reducing rates of hospital-acquired infections particularly in the wake of increasing public attention. However, it is time for budget preparation and your financial officer is concerned about the escalating costs associated with patient isolation and barrier precautions/personal protective equipment. Having become aware of the high costs associated with these interventions, you start to wonder about the wisdom of spending so much in this area. Your hospital administration wants your direction on next year's expenditures. You are debating whether the expense is worthwhile and advise your hospital administration accordingly. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5615771 Thu, 19 Jan 2012 05:00:00 +0100 5615771 http://www.medworm.com/index.php?rid=5615770&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F201 Acute kidney injury (AKI) in ICU patients is typically associated with other severe conditions that require special attention when renal replacement therapy (RRT) is performed. RRT includes a wide range of techniques, each with specific characteristics and implications for use in ICU patients. In the present review we discuss a wide range of conditions that can occur in ICU patients who have AKI, and the implications this has for RRT. Patients at increased risk for bleeding should be treated without anticoagulation or with regional citrate anticoagulation. In patients who are haemodynamically unstable, continuous therapies are most often employed. These therapies allow slow removal of volume and guarantee a stable blood pH. In patients with cerebral oedema, continuous therapy is recommende... Critical Care journals http://www.medworm.com/rss/comments.php?id=5615770 Thu, 19 Jan 2012 05:00:00 +0100 5615770 http://www.medworm.com/index.php?rid=5602753&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR10 Conclusions: The novel findings of our study are that one-month surviving septic patients showed higher COXq/CSa than non-surviving individuals, that patients from JT mtDNA haplogroup showed a higher COXq/CSa ratio and that JT patients had a higher one month survival than patients from other mtDNA haplogroups. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5602753 Tue, 17 Jan 2012 05:00:00 +0100 5602753 http://www.medworm.com/index.php?rid=5602752&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F404 - (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5602752 Tue, 17 Jan 2012 05:00:00 +0100 5602752 http://www.medworm.com/index.php?rid=5602756&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR7 Conclusions: Multiple endothelial-derived molecules are positively correlated with the presence of sepsis in humans, and variably correlated to other clinically-important outcomes. The clinical utility of these biomarkers is limited by a lack of assay standardization, unknown receiver operating characteristics and lack of validation. Additional large-scale prospective clinical trials will be required to determine the clinical utility of biomarkers of endothelial activation in the management of patients with sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5602756 Mon, 16 Jan 2012 05:00:00 +0100 5602756 http://www.medworm.com/index.php?rid=5602755&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR8 IntroductionCyclic alveolar recruitment (R/D) is an important mechanism of ventilator associated lung injury. In experimental models this process can be measured with high temporal resolution by detection of respiratory-dependent oscillations of the paO2 ([increment] paO2). A previous study showed that end-expiratory collapse can be prevented by an increased respiratory rate in saline-lavage rabbits. The current study compares the effects of increased PEEP versus an individually titrated respiratory rate (RRind) on intra-tidal amplitude of [increment] paO2 and on average paO2 in saline-lavaged pigs. Methods: Acute lung injury was induced by bronchoalveolar lavage in 16 anaesthetized pigs. R/D was induced and measured by a fast-responding intra-aortic probe measuring paO2.Ventilatory interv... Critical Care journals http://www.medworm.com/rss/comments.php?id=5602755 Mon, 16 Jan 2012 05:00:00 +0100 5602755 http://www.medworm.com/index.php?rid=5602754&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR9 Conclusions: Inflammation likely contributes to liver damage at early injurious phase but improves hepatocyte regeneration at a late time point, and prolonged anti-inflammation therapy at late phase is not beneficial. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5602754 Mon, 16 Jan 2012 05:00:00 +0100 5602754 http://www.medworm.com/index.php?rid=5591153&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F105 Standardization of data collection in severely injured trauma patients in order to find the best performance and practice has been an issue since more than 20 years. The incidence of trauma has decreased and outcomes have improved over the past decades. Trauma, however, still remains an important public health problem and is listed by the World Health Organization as a leading cause of death and disability. Ringdal and colleagues prove the feasibility on a basic level in their prospective, intercontinental study showing the results of the Utstein Trauma Template. In depth analysis is currently only partially possible. The future of standardizing data collection in trauma looks bright. However, bridging and cross linking is necessary in the future to a great extent. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5591153 Thu, 12 Jan 2012 05:00:00 +0100 5591153 http://www.medworm.com/index.php?rid=5591155&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR6 Conclusion: Critically ill patients surviving the admission to a medical ICU had slightly higher minimum and marginally higher average COHb levels when compared to non-survivors. Even though the observed differences are statistically significant, the minute margins would not qualify COHb as a predictive marker for ICU mortality. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5591155 Wed, 11 Jan 2012 05:00:00 +0100 5591155 http://www.medworm.com/index.php?rid=5591154&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F104 Airway management during cardiac arrests is a controversial area. There are advantages to the provision of a patent airway with an airway adjunct, especially as this can optimize oxygenation and carbon dioxide clearance as well as facilitate continuous compressions. These advantages come at a potential cost, in particular errors in placement of the devices and interruption to compressions necessitated for insertion. The widespread availability of supraglottic airways (SGAs), their ease of insertion, and their ability to be inserted without interruptions to compressions have meant that the role of the definitive airway device - the endotracheal tube - is being challenged. In the previous issue of Critical Care, a study from Japan reported the use of advanced airways in more than 5,000 victi... Critical Care journals http://www.medworm.com/rss/comments.php?id=5591154 Wed, 11 Jan 2012 05:00:00 +0100 5591154 http://www.medworm.com/index.php?rid=5591156&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F103 Copeptin is a peptide derived from pre-provasospression along with arginine vasospressin. In the setting of aneurysmal subarachnoid hemorrhage (SAH), elevated serum copeptin levels correlate with vasospasm, inpatient mortality, mortality at 1 year, and poor functional outcome at 1 year. The potential role of serum copeptin levels in the management of patients with aneurysmal SAH is promising and should be explored further. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5591156 Tue, 10 Jan 2012 05:00:00 +0100 5591156 http://www.medworm.com/index.php?rid=5575746&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F101 The description of a new score of nutrition risk in critically ill patients in this issue of Critical Care is very appropriate and timely. However, the use of this score will probably not help the clinician to improve the prescription of nutrition therapy, especially when major uncertainties are raised about the definition of adequate nutrition. The validation of the score will require the use of outcome variables susceptible to be influenced by nutrition, such as surrogate markers of muscle function. Meanwhile the educational value of a score of nutrition risk is undisputed in settings where the use of scores is incorporated in the usual practice. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575746 Mon, 09 Jan 2012 05:00:00 +0100 5575746 http://www.medworm.com/index.php?rid=5575745&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F102 Despite their difficult definition and taxonomy, critical incidents in intensive care are imperative to be studied, since they may be followed by adverse events and compromised patient safety. Identifying recurring patterns and factors contributing to critical incidents constitute a prerequisite for developing effective preventive strategies. Self-reporting methodology, although widely used for studying critical incidents, has been criticized in terms of reliability and may considerably underestimate both overall frequency and specific types of them. Promotion of non-blaming culture, analysis of critical incident reports and development of clinical recommendations are expected to minimize critical incidents in the future. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575745 Mon, 09 Jan 2012 05:00:00 +0100 5575745 http://www.medworm.com/index.php?rid=5575744&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F401 Kuster and colleagues (Critical Care 15:R182) recently reported that during seasonal influenza febrile patients admitted to critical care with a diagnosis of pneumonia or respiratory infection are likely to have a diagnosis of influenza. Prompt identification of patients with influenza facilitates early empirical therapy and infection control. However, optimal management of patients requires confirmatory diagnostic microbiological testing and is exemplified by the case of a young male admitted at the peak of seasonal influenza. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575744 Mon, 09 Jan 2012 05:00:00 +0100 5575744 http://www.medworm.com/index.php?rid=5575743&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2F403 No abstract as 250 word letter (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575743 Mon, 09 Jan 2012 05:00:00 +0100 5575743 http://www.medworm.com/index.php?rid=5575748&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR4 IntroductionThe benefits of higher PEEP in patients with ARDS have been modest, but few studies have fully tested the "open-lung hypothesis". This hypothesis states that most of the collapsed lung tissue observed in ARDS can be reversed at an acceptable clinical cost, potentially resulting in better lung protection, but requiring more intensive maneuvers. The short/middle-term efficacy of a Maximum Recruitment Strategy (MRS) was recently described in a small physiological study. The present study extends those results, describing a case-series of non-selected patients with early, severe ARDS submitted to MRS, and followed till Hospital discharge or death. Methods: MRS guided by thoracic CT included two parts: a recruitment phase to calculate opening pressures (incremental steps under press... Critical Care journals http://www.medworm.com/rss/comments.php?id=5575748 Sun, 08 Jan 2012 05:00:00 +0100 5575748 http://www.medworm.com/index.php?rid=5575747&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR5 Conclusion: Alcoholic ICU patients with chronic complications of alcoholism have substantially increased 30-day and three year mortality. In contrast, alcoholics without complications have no increased 30-day and only slightly increased three year mortality. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575747 Sun, 08 Jan 2012 05:00:00 +0100 5575747 http://www.medworm.com/index.php?rid=5575750&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR2 IntroductionThe accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI. Methods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification. Results: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 [IQR, 91-203] umol/l vs. 97 [76-132... Critical Care journals http://www.medworm.com/rss/comments.php?id=5575750 Sat, 07 Jan 2012 05:00:00 +0100 5575750 http://www.medworm.com/index.php?rid=5575749&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR3 Conclusions: Early initiation of low-dose corticosteroid therapy was significantly associated with decreased mortality. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5575749 Sat, 07 Jan 2012 05:00:00 +0100 5575749 http://www.medworm.com/index.php?rid=5567320&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F16%2F1%2FR1 Conclusions: EVLW was associated with degree of lung injury and mortality, regardless of the index used, confirming that it may be used as a bedside indicator for disease severity. Using EVLW as a bedside test conferred added diagnostic value for the identification of patients with lung injury. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5567320 Tue, 03 Jan 2012 05:00:00 +0100 5567320 http://www.medworm.com/index.php?rid=5556236&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR297 Conclusions: In inflamed patients the proinflammatory cytokine IL-8 was associated with delirium. While in non-inflamed patients anti-inflammatory cytokine IL-10 and A-beta1-42/40 were associated with delirium. This suggests that the underlying mechanism governing the development of delirium in inflamed patients differs from that in non-inflamed patients. Finally, elevated levels of amyloid-beta correlate with long-term subjective cognitive impairment delirium may represent the first sign of a (subclinical) dementia process. Future studies need to confirm these results. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5556236 Thu, 29 Dec 2011 05:00:00 +0100 5556236 http://www.medworm.com/index.php?rid=5548832&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F462 N/A (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5548832 Thu, 29 Dec 2011 05:00:00 +0100 5548832 http://www.medworm.com/index.php?rid=5548831&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1022 Probiotics are live micro-organisms with a health promoting effect. Because of their immunomodulating capacity as well as improvement of gut barrier function probiotics have the capacity to prevent infectious complications in a variety of clinical setting. Now selected probiotics show potential for improving the clinical outcome of severe trauma patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5548831 Thu, 29 Dec 2011 05:00:00 +0100 5548831 http://www.medworm.com/index.php?rid=5531490&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F317 Conclusions: Late-initiation of PN was associated with faster recovery and fewer complications, when compared with early-initiation.Trial RegistrationNCT00512122 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5531490 Thu, 22 Dec 2011 05:00:00 +0100 5531490 http://www.medworm.com/index.php?rid=5531489&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1014 Childbirth is a major event in the lives of mothers and their families. Critical illness in pregnancy is uncommon but may arise from conditions unique to pregnancy, those exacerbated by pregnancy and coincidental conditions. According to the latest Confidential Enquiry into Maternal Deaths in the UK, haemorrhage remains the leading direct cause of mortality, however, there has been an increase in mortality due to indirect causes. The obstetric population has changed over the past decade and we are caring for much older mothers with pre-existing disorders and advanced chronic medical conditions. It is therefore essential to adopt an early multidisciplinary approach for the care of these women. With birth rates increasing, complex caseloads and changes in training of both medical and midwife... Critical Care journals http://www.medworm.com/rss/comments.php?id=5531489 Thu, 22 Dec 2011 05:00:00 +0100 5531489 http://www.medworm.com/index.php?rid=5531488&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1021 Thromboelastography and thromboelastometry represent visco-elastic diagnostic methodologies with promising application to diseases of altered coagulation. Their use in trauma induced coagulopathy as a means of assessing the real time status of the patient's functional coagulation profile in addition to its impact on effective and appropriate use of blood product support has been gaining acceptance among trauma surgeons, anesthesiologists, and transfusion medicine specialists. However, the ability of visco-elastic testing to augment or supplant conventional coagulation testing for the diagnosis and management of trauma induced coagulopathy remains controversial. Many of these issues pertain to the differences in methodology, instrumentation, logic, accessibility, ease of use, operator varia... Critical Care journals http://www.medworm.com/rss/comments.php?id=5531488 Thu, 22 Dec 2011 05:00:00 +0100 5531488 http://www.medworm.com/index.php?rid=5510947&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR296 Conclusions: Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5510947 Fri, 16 Dec 2011 05:00:00 +0100 5510947 http://www.medworm.com/index.php?rid=5510950&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F461 Despite Kett et al argue that they provide data to support an advantage of anidulafungin over fluconazole for the treatment of critically ill non-neutropenic patients with invasive Candida infections, there are several concerns that may limit this interpretation, namely the different duration of intravenous therapy, the choice of a surrogate endpoint that was not predictive of mortality and a superiority claim when the original study was designed as a non-inferiority trial. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5510950 Thu, 15 Dec 2011 05:00:00 +0100 5510950 http://www.medworm.com/index.php?rid=5510949&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1019 Positional strategies have been proposed for mechanically ventilated patients with acute respiratory distress syndrome. Despite different physiological mechanisms involved, oxygenation improvement has been demonstrated with both prone and upright position. In this issue of Critical Care, Robak and colleagues reported the first study evaluating the short term effects of combining prone and upright positioning. The combined position enhanced the response rate in terms of oxygenation. Other benefits, such as a reduction in ventilator-associated pneumonia and a better enteral feeding tolerance can potentially be expected. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5510949 Thu, 15 Dec 2011 05:00:00 +0100 5510949 http://www.medworm.com/index.php?rid=5510948&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1020 This study expands our knowledge on the diagnostic power of suPAR, confirms its prognostic value and raises the demand of future studies investigating the pathogenic involvement of suPAR. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5510948 Thu, 15 Dec 2011 05:00:00 +0100 5510948 http://www.medworm.com/index.php?rid=5510951&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR295 Conclusions: Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries though influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5510951 Wed, 14 Dec 2011 05:00:00 +0100 5510951 http://www.medworm.com/index.php?rid=5499971&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR293 Conclusions: Our data suggest that a protocol of no sedation applied to critically ill patients undergoing mechanical ventilation does not increase the risk of long term psychological sequelae after intensive care compared to standard treatment with sedation. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5499971 Tue, 13 Dec 2011 05:00:00 +0100 5499971 http://www.medworm.com/index.php?rid=5499970&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR294 Conclusion: In most patients, the EELV technique has good reproducibility and accuracy even at high PEEP. At high pressuresit accuracy may be limited in case of leaks. The minimal predicted increase in lung volume may help to check for accuracy. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5499970 Tue, 13 Dec 2011 05:00:00 +0100 5499970 http://www.medworm.com/index.php?rid=5499972&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1018 Diabetes mellitus is increasingly prevalent and associated with significant end organ damage that one may presume to impact upon critical illness. However, Siegelaar and colleagues present data that suggest, excepting those patients admitted to a cardiac intensive care unit (ICU), the presence of diabetes mellitus is not associated with increased mortality in critically ill patients. It is not possible to unpick how unmeasured parameters such as glycaemic control, the nature of whether type I or type II, or concomitant drugs therapy confound the results. Nevertheless, the results are consistent with many risk adjustment models used in the critically ill and clinical practice that tolerates mild hyperglycaemia in all critically ill. Is it even possible that diabetes mellitus is protective? ... Critical Care journals http://www.medworm.com/rss/comments.php?id=5499972 Mon, 12 Dec 2011 05:00:00 +0100 5499972 http://www.medworm.com/index.php?rid=5491532&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F316 Conclusion: In a collaborative network of community ICUs, a multi-faceted quality improvement intervention improved adoption of care practices. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5491532 Fri, 09 Dec 2011 05:00:00 +0100 5491532 http://www.medworm.com/index.php?rid=5491534&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F460 A ballanced distribution between study and intervention group could be observed in our randomized prospective trial. This raised a comment and request by dr.Munis to clarify the randomizatio process. Besides answering this request we conclude that also another factors could contribute to this ballanced distribution. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5491534 Thu, 08 Dec 2011 05:00:00 +0100 5491534 http://www.medworm.com/index.php?rid=5491533&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F315 Conclusions: Among critically ill adult patients, dalteparin was not superior to UFH at preventing proximal lower extremity DVTs. There is a suggestion that dalteparin might be superior to UFH at preventing pulmonary embolism but a larger trial is necessary to confirm this result. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5491533 Thu, 08 Dec 2011 05:00:00 +0100 5491533 http://www.medworm.com/index.php?rid=5481860&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F242 This report is intended to provide guidance to practitioners, hospitals, and policy makers. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5481860 Thu, 08 Dec 2011 04:38:34 +0100 5481860 http://www.medworm.com/index.php?rid=5481859&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F243 The H1N1 flu pandemic led to a rediscovery of the extracorporeal support, proving its power in hypoxemic emergencies and providing evidence that the transport of patients with life threatening hypoxemia may be safely accomplished after extracorporeal respiratory support has been started in the hospital of origin. Clinical results during the flu pandemic (survival rate around 70%) , more than whatever randomized trial, led to a worldwide acceptance of the use of membrane lungs. The indications for ECMO nowadays are actually enlarged towards bridging to lung transplant, correcting lung hyperinflation in COPD and, possibly, to provide respiratory support in ARDS even without intubation. The actual enthusiasm for this technique in its various aspects, however, should not obscure the considerat... Critical Care journals http://www.medworm.com/rss/comments.php?id=5481859 Thu, 08 Dec 2011 04:38:34 +0100 5481859 http://www.medworm.com/index.php?rid=5481858&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F314 Aircraft carriers, electrical power grids, and wildland firefighting, although seemingly different, are exemplars of high reliability organizations (HROs)- organizations that have the potential for catastrophic failure, yet engage in nearly error-free performance. HROs commit to safety at the highest level and adopt a special approach to its pursuit. High reliability organizing has been studied and discussed for some time in other industries and is receiving increasing attention in healthcare, particularly in high-risk settings like the intensive care unit (ICU). The essence of high reliability organizing is a set of principles that enable organizations to focus attention on emergent problems and to deploy the right set of resources to address those problems. HROs behave in ways that somet... Critical Care journals http://www.medworm.com/rss/comments.php?id=5481858 Thu, 08 Dec 2011 04:38:34 +0100 5481858 http://www.medworm.com/index.php?rid=5481857&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F459 NA (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5481857 Thu, 08 Dec 2011 04:38:34 +0100 5481857 http://www.medworm.com/index.php?rid=5481862&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR291 The objectives of the Acute Heart Failure Database (AHEAD) registry are to assess patient characteristics, aetiology, treatment and outcome of AHF. Methods: The AHEAD Main registry includes patients hospitalised for AHF in 7 centres with a Cath Lab Service in Czech Republic. The data were collected from September 2006 till October 2009. The inclusion criteria for the database adhere to the European guidelines for AHF (2005) and patients were systematically classified according to the basic syndromes, type and aetiology of AHF. Results: Of 4,153 patients, 12.7% patients died during hospitalisation. The median length of hospitalisation was 7.1 days. Mean age of patients was 71.5+/-12.4 years; males were younger (68.6+/-12.4 years) compared with females (75.5+/-11.5 years) (P (Source: Critica... Critical Care journals http://www.medworm.com/rss/comments.php?id=5481862 Wed, 07 Dec 2011 05:00:00 +0100 5481862 http://www.medworm.com/index.php?rid=5481861&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1009 Reversing the immunoparalysis associated with septic shock remains a priority for improving the outcome of patients suffering from sepsis. The efficacy of future therapies may be better studied under an effective system of patient stratification. Gene expression biomarkers offer a mechanism by which patients may be appropriately stratified in such clinical trials. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5481861 Wed, 07 Dec 2011 05:00:00 +0100 5481861 http://www.medworm.com/index.php?rid=5481866&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F240 In this review, 21 original papers published last year in the respirology and critical care sections of Critical Care are classified and analyzed in the following categories: mechanical ventilation, lung recruitment maneuvers, and weaning; the role of positive end-expiratory pressure in acute lung injury models; animal models of ventilator-induced lung injury; diaphragmatic dysfunction; the role of mechanical ventilation in heart-lung interaction; and miscellanea. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5481866 Mon, 05 Dec 2011 05:00:00 +0100 5481866 http://www.medworm.com/index.php?rid=5481865&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F236 This review summarizes new insights in the pathophysiologic implications of inflammation and microvascular alterations in organ dysfunction, as well as genetic factor contribution, from clinical and experimental studies that were published in 2010 in Critical Care in the fields of multiple organ dysfunction and sepsis. New diagnostic and prognostic markers of organ dysfunction are presented. Evaluations of novel therapeutic strategies, including implementation of international guidelines, modulation of inflammation and coagulation, and prevention of ventilator-induced lung injury and acute kidney injury, are reported. The results of these experimental studies and clinical trials are discussed in the context of the current relevant scientific and clinical background. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5481865 Mon, 05 Dec 2011 05:00:00 +0100 5481865 http://www.medworm.com/index.php?rid=5481864&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F237 In 2010 Critical Care published a large number of articles on critical care aspects of neurologic and neurosurgical conditions. These aspects included investigation of diagnostic criteria for bacterial meningitis, critical illness myopathy and their relationship to systemic inflammation. A number of studies investigated the biology of sepsis-related delirium, its biomarkers, its relationship to inflammation and its impact on outcome. Other teams reported on the use of magnetic resonance imaging, biomarkers and electroencephalogram to predict outcome in patients who were comatose following cardiac arrest. Our understanding of the pathophysiology as well as management of subarachnoid hemorrhage was addressed in several papers. Topics included the effect of hemodynamic treatment of delayed ce... Critical Care journals http://www.medworm.com/rss/comments.php?id=5481864 Mon, 05 Dec 2011 05:00:00 +0100 5481864 http://www.medworm.com/index.php?rid=5481863&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F239 This review will summarize some of the data published in 2010 and focus on papers published in Critical Care in regard to cardiac arrest and cardiopulmonary resuscitation. In particular, we discuss the latest research in therapeutic hypothermia after cardiac arrest, including methods of inducing hypothermia, potential protective mechanisms, spontaneous hypothermia versus therapeutic hypothermia, and several predictors of outcome. Furthermore, we will discuss the effects of bystander-initiated cardiopulmonary resuscitation (CPR) in patients with physician-assisted advanced cardiac life support, the role of hypercapnea in near-death experiences during cardiac arrest, markers of endothelial injury and endothelial repair after CPR, and the prognostic value of cell-free plasma DNA as a marker o... Critical Care journals http://www.medworm.com/rss/comments.php?id=5481863 Mon, 05 Dec 2011 05:00:00 +0100 5481863 http://www.medworm.com/index.php?rid=5472926&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR290 Prophylactic administration of probiotics appears to promote a return to a more normal Th1/Th2 balance in patients with severe traumatic brain injury, which may contribute to a decreased nosocomial infection rate. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5472926 Fri, 02 Dec 2011 05:00:00 +0100 5472926 http://www.medworm.com/index.php?rid=5472925&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1007 Sepsis continues to pose a clear challenge as one of the most difficult and costly problems to treat and prevent. Sepsis is caused by systemic or localized infections that damage the integrity of microcirculation in multiple organs. The challenge of sepsis and its long-term sequelae was addressed by the National Institutes of Health National Heart Lung and Blood Institute Division of Blood Diseases and Resources. Defining sepsis as severe endothelial dysfunction syndrome that causes multiorgan failure in response to intravascular or extravascular microbial agents, the National Heart Lung and Blood Institute panel proposed the concept of genome wars as a platform for new diagnostic, therapeutic, and preventive approaches to sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5472925 Fri, 02 Dec 2011 05:00:00 +0100 5472925 http://www.medworm.com/index.php?rid=5463763&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F234 In modern critical care, the paradigm of therapeutic nutrition is replacing traditional supportive nutrition. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that can attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula can positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality.In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patie... Critical Care journals http://www.medworm.com/rss/comments.php?id=5463763 Wed, 30 Nov 2011 05:00:00 +0100 5463763 http://www.medworm.com/index.php?rid=5463762&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F235 The objective of this article is to review research in the area of DAMPs, their recognition by the innate immune system, their role in VILI and the potential utility of blocking DAMP-signaling pathways to reduce VILI in the critically ill. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463762 Wed, 30 Nov 2011 05:00:00 +0100 5463762 http://www.medworm.com/index.php?rid=5463761&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR289 IntroductionIn animal models of systemic inflammation, the endogenous nucleoside adenosine controls inflammation and prevents organ injury. Dipyridamole blocks the cellular uptake of endogenous adenosine and increases the extracellular adenosine concentration. We studied the effects of oral dipyridamole treatment on innate immunity and organ injury during human experimental endotoxemia. Methods: In a randomized double-blind placebo-controlled study, twenty healthy male subjects received 2 ng/kg E. Coli endotoxin (LPS) intravenously following seven day pretreatment with dipyridamole, 200 mg slow release twice daily, or placebo. Results: Nucleoside transporter activity on circulating erythrocytes was reduced by dipyridamole with 89+/-2% (p (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463761 Wed, 30 Nov 2011 05:00:00 +0100 5463761 http://www.medworm.com/index.php?rid=5463760&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F313 The aviation industry has made significant progress in identifying the skills and behaviours that result in effective teamwork. Its conceptualisation of teamwork, development of training programmes, and design of assessment tools are highly relevant to the intensive care unit (ICU). Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful and uncertain conditions. However, in comparison to aviation, there are substantial differences in the nature of work and structure of teams in ICU. Whilst intensive care medicine may wish to utilise the advances made by the aviation industry in terms of conceptualising team skills and implementing team training programmes, interventions must be tailored to the highl... Critical Care journals http://www.medworm.com/rss/comments.php?id=5463760 Wed, 30 Nov 2011 05:00:00 +0100 5463760 http://www.medworm.com/index.php?rid=5463759&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1012 Hypoglycemia is consistently associated with increased risk of death in hospital patients in general, patients treated in intensive care units and patients with Type II diabetes recruited to large randomised controlled trials. In 1965 Sir Austin Bradford Hill elucidated nine characteristics that help establish a causal relationship between exposure to a potentially harmful substance or event (in the current context hypoglycemia) and the onset of disease or death; hypoglycemia exhibits some of those characteristics but others remain to be explored. Whilst we await more robust data, common sense dictates that clinicians avoid causing hypoglycemia whenever possible. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463759 Wed, 30 Nov 2011 05:00:00 +0100 5463759 http://www.medworm.com/index.php?rid=5463758&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1013 The Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) is an immunoreceptor whose role is to amplifiy the inflammatory response mediated by the Toll-Like and Nod-Like Receptors engagement. As the expression of TREM-1 is believed to be up-regulated during infection, this protein has been studied as a sepsis biomarker. In this issue of Critical Care, Su and colleagues report on the usefulness of urinary soluble TREM-1 in diagnosing sepsis and its severity. Importantly, they describe for the first time that urinary sTREM-1 measurement is able to predict the development of sepsis associated acute kidney injury (AKI). Therefore, were these results confirmed by larger studies, urinary sTREM-1 may become a new biomarker for sepsis-associated AKI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463758 Wed, 30 Nov 2011 05:00:00 +0100 5463758 http://www.medworm.com/index.php?rid=5463765&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR287 Conclusion: This review has shown a number of risk factors to be significantly associated with the development of IFD in critically ill adults. Methodological limitations were identified in the design and conduct of studies in this area, and caution should be used in their interpretation. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463765 Tue, 29 Nov 2011 05:00:00 +0100 5463765 http://www.medworm.com/index.php?rid=5463764&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR288 Plasma copeptin level is substantially higher in patients with aneurysmal subarachnoid hemorrhage (SAH) compared to healthy controls, and is an independent predictor of functional outcome and death. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463764 Tue, 29 Nov 2011 05:00:00 +0100 5463764 http://www.medworm.com/index.php?rid=5463766&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1010 Though the benefits of lung protective ventilation (LPV) in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) have been known for more than a decade, widespread clinical adoption has been slow. Han et al. demonstrate that women with ALI/ARDS are less likely than men to receive LPV, though this disparity resolves when the analysis is adjusted for patient height. This analysis identifies patient height as a significant factor in predicting provider adherence with LPV guidelines, and illuminates why some disparities in intensive care exist and how they may be resolved via improved utilization of evidence-driven protocols. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5463766 Mon, 28 Nov 2011 05:00:00 +0100 5463766 http://www.medworm.com/index.php?rid=5453293&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR286 Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5453293 Mon, 28 Nov 2011 05:00:00 +0100 5453293 http://www.medworm.com/index.php?rid=5453292&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F309 Communication failures are a significant contributor to medical errors that harm patients. Critical care delivery is a complex system of inter-professional work that is distributed across time, space, and multiple disciplines. Because health-care education and delivery remains siloed by profession, we lack a shared framework within which we discuss and subsequently optimize patient care. Furthermore, our disparate professional perspectives and interests often interfere with our ability to effectively prioritize individual care. It is important, therefore, to develop a cognitively shared framework for understanding a patient's severity of illness and plan of care across multiple, traditionally poorly communicating disciplines. We suggest that the "phases of illness paradigm" will facilitate... Critical Care journals http://www.medworm.com/rss/comments.php?id=5453292 Mon, 28 Nov 2011 05:00:00 +0100 5453292 http://www.medworm.com/index.php?rid=5453291&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F455 In conclusion, we believe that this meta-analysis does not give any scientifically proven conclusion and creates only conclusion. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5453291 Mon, 28 Nov 2011 05:00:00 +0100 5453291 http://www.medworm.com/index.php?rid=5446496&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR285 Conclusions: The analysis shows that MRSA IDs and structural parameters differ considerably between ICUs. In response, ICUs have combined screening and control measures in many ways to achieve various individual solutions. The incidence of imported MRSA cases might be helpful for consideration in the planning of MRSA control programmes. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446496 Fri, 25 Nov 2011 05:00:00 +0100 5446496 http://www.medworm.com/index.php?rid=5446500&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR282 This study investigates the impact of response time reliability (RTR) on cardio pulmonary resuscitation (CPR) incidence and resuscitation success using return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score and data from seven German EMS systems participating in the German Resuscitation Registry. Methods: Anonymized patient data after out of hospital cardiac arrest from 2006 to 2009 of seven EMS systems in Germany were analysed to socioeconomic factors (population, area, EMS unit hours), process quality (response time reliability, CPR incidence, special CPR measures, prehospital cooling), patient factors (age, gender, cause of cardiac arrest, bystander CPR). Endpoints were defined as ROSC, admission to hospital, 24 hour survival and hospital discharge rate. For statisti... Critical Care journals http://www.medworm.com/rss/comments.php?id=5446500 Thu, 24 Nov 2011 05:00:00 +0100 5446500 http://www.medworm.com/index.php?rid=5446499&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR283 Conclusions: The analysis of the waveforms generated by ventilators has a significant positive effect on physiological and patients' centered outcomes during acute exacerbation of COPD. The acquisition of specific skills in this field should be encouraged. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446499 Thu, 24 Nov 2011 05:00:00 +0100 5446499 http://www.medworm.com/index.php?rid=5446498&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1011 In the present issue of Critical Care Bojan and co-workers reported their experiences with paediatric high-frequency oscillatory ventilation (HFOV) after paediatric cardiac surgery. A total number of 120 patients were treated with HFOV at the day of surgery, thus excluding rescue HFOV use. Their main finding was that the duration of MV was significantly shorter in patients where HFOV was initiated at the day of surgery. Especially interesting about their work is that they used HFOV when there was evidence of pulmonary hypertension or right ventricular (RV) failure in their patients. This is an interesting approach, as it is often assumed that high intra-thoracic pressures increase RV afterload and may thus enhance RV dysfunction. Their findings may be explained by the fact that they were a... Critical Care journals http://www.medworm.com/rss/comments.php?id=5446498 Thu, 24 Nov 2011 05:00:00 +0100 5446498 http://www.medworm.com/index.php?rid=5446497&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F456 We reported a significant increase in DeltaCO2 between RR 10 and RR 16; (4.2+/-1.8 and 7.6+/-1.7, respectively).We underline the effect of moderate hyperventilation on CO2 gap. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446497 Thu, 24 Nov 2011 05:00:00 +0100 5446497 http://www.medworm.com/index.php?rid=5446504&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR278 We present initial simulation data for a novel closed-loop fluid-management algorithm (LIR: Learning Intravenous Resuscitator). Methods: The performance of the closed-loop algorithm was tested in three phases using a patient simulator including a pulse pressure variation output. In the first phase, LIR was tested in three different hemorrhage scenarios and compared to no management. In the second phase, we compared LIR to 20 practicing anesthesiologists for the management of a simulated hemorrhage scenario. In the third phase, LIR was tested under conditions of noise and artifact in the dynamic predictor. Results: In the first phase we observed a significant difference between the unmanaged and the LIR groups in moderate to large hemorrhages in heart rate (76+/-8 vs 141+/-29 bpm), mean art... Critical Care journals http://www.medworm.com/rss/comments.php?id=5446504 Wed, 23 Nov 2011 05:00:00 +0100 5446504 http://www.medworm.com/index.php?rid=5446503&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR279 Conclusions: The extrapolation method appears robust against variations in thoracic anatomy which further supports its accuracy and potential usefulness for clinical and experimental application of quantitative CT. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446503 Wed, 23 Nov 2011 05:00:00 +0100 5446503 http://www.medworm.com/index.php?rid=5446502&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR280 Conclusions: rs2027432 and rs12048215 polymorphisms might be used as relevant risk estimates for the development of sepsis and multiple organ dysfunction syndrome in patients with major trauma, in which the rs2027432 might be a functional SNP. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446502 Wed, 23 Nov 2011 05:00:00 +0100 5446502 http://www.medworm.com/index.php?rid=5446501&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR281 Conclusions: In summary, TCD was found to be a valuable bedside test to detect arterial alterations in patients with bacterial meningitis. These patients have an increased risk of stroke. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5446501 Wed, 23 Nov 2011 05:00:00 +0100 5446501 http://www.medworm.com/index.php?rid=5436328&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR276 Conclusions: Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5436328 Tue, 22 Nov 2011 05:00:00 +0100 5436328 http://www.medworm.com/index.php?rid=5436327&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR277 Conclusions: In its initial phase, sepsis is associated with a significant alteration in the composition of the GFB-associated glycocalyx, with loss of GFB permselectivity as documented by albumin leakage into urine. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5436327 Tue, 22 Nov 2011 05:00:00 +0100 5436327 http://www.medworm.com/index.php?rid=5436329&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR275 Conclusions: Bivalirudin as the sole anticoagulant can be safely used for postcardiotomy ECMO, with a better coagulation profile, less bleeding and allogeneic transfusions. No safety issues were raised by this study, and costs are reduced in bivalirudin-treated patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5436329 Sun, 20 Nov 2011 05:00:00 +0100 5436329 http://www.medworm.com/index.php?rid=5427064&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1008 In this study, although decreased renal blood flow and increased renal vascular resistance was present in some of the animals that developed S-AKI, in other animals, inflammatory activation without decreased renal blood flow and increased renal vascular resistance was seen. Systemic hemodynamic findings provided little guide to renal hemodynamics or risk of S-AKI. The study highlights the extraordinary complexity of S-AKI and the need for clinicians to recognize our limited understanding of its pathogenesis and the weakness of the decreased perfusion paradigm as the sole explanation for the loss of renal function seen in severe sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5427064 Fri, 18 Nov 2011 05:00:00 +0100 5427064 http://www.medworm.com/index.php?rid=5415899&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR272 This study investigated the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. Methods: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team activation and had an arterial cannula inserted. Blood was sampled a median of 68 min (IQR 48-88) post-injury. Data on demography, biochemistry, injury severity score (ISS) and mortality were recorded. Plasma/serum was analyzed for biomarkers reflecting tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, Annexin V, thrombomodulin, syndecan-1), coagulation activation/inhibition (prothrombinfragment 1+2, thrombin/antithrombin-complexes, antithrom... Critical Care journals http://www.medworm.com/rss/comments.php?id=5415899 Thu, 17 Nov 2011 05:00:00 +0100 5415899 http://www.medworm.com/index.php?rid=5415904&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR270 Pulmonary levels of soluble urokinase-type plasminogen activator receptor (suPAR) may be useful for diagnosis of inhalation injury, while systemic suPAR levels may be prognostic for duration of mechanical ventilation and ICU-stay. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415904 Wed, 16 Nov 2011 05:00:00 +0100 5415904 http://www.medworm.com/index.php?rid=5415903&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR271 Conclusions: High blood pressure requiring intravenous therapy is currently managed with a variety of agents in Europe, the most commonly used being nitroglycerin, urapidil, and clonidine. These patients have substantial concomitant morbidity and mortality, and intravenous antihypertensive treatment is associated with hypotension in almost 10% of cases. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415903 Wed, 16 Nov 2011 05:00:00 +0100 5415903 http://www.medworm.com/index.php?rid=5415902&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F312 Research carried out in the field of Work and Organizational Psychology shows that work unit climate and culture are important determinants of work unit performance. We briefly summarize what we have learnt about the climate-performance relationship in work units distinct from ICUs. Then, we show how the ICU culture can be measured, and summarize research on the culture-performance relationship in ICUs. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415902 Wed, 16 Nov 2011 05:00:00 +0100 5415902 http://www.medworm.com/index.php?rid=5415901&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F452 New therapeutic measures are available for the management of rhabdomyolysis. To enable the design of future studies which will assess the clinical benefit of these interventions, we sought to first determine the current clinical outcomes of patients with rhabdomyolysis admitted to intensive care units within England, Wales and Northern Ireland. Here in we describe the duration of intensive care and hospital admissions associated with rhabdomyolysis, and the early survival measures for this population. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415901 Wed, 16 Nov 2011 05:00:00 +0100 5415901 http://www.medworm.com/index.php?rid=5415900&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F453 Wan and colleagues (Critical Care 15:R159) recently reported a case series of patients with refractory delirium successfully treated with the atypical antipsychotic drug quetiapine. This class of medication is used infrequently by critical care physicians at present and offers a potentially useful treatment for a group of patients who are clinically challenging to manage. However, larger studies are required to evaluate both efficacy and adverse events in a critically ill population. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415900 Wed, 16 Nov 2011 05:00:00 +0100 5415900 http://www.medworm.com/index.php?rid=5415907&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR267 Conclusions: No significant differences in clinical cure, microbiologic cure and survival were detected among bacteremic patients receiving shorter versus longer duration antibiotic therapy. An adequately powered randomized trial of bacteremic patients is needed to confirm these findings. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415907 Tue, 15 Nov 2011 05:00:00 +0100 5415907 http://www.medworm.com/index.php?rid=5415906&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR268 IntroductionTo develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU). Methods: A prospective observational study of patients expected to stay in the >24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415906 Tue, 15 Nov 2011 05:00:00 +0100 5415906 http://www.medworm.com/index.php?rid=5415905&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR269 IntroductionRapid response teams (RRTs) have been shown to reduce cardiopulmonary arrests outside the intensive care unit (ICU). Yet the utility of RRTs remains in question, as most large studies have failed to demonstrate a significant reduction in hospital-wide mortality following RRT implementation. Methods: A cohort design with historical controls was used to determine the effect on hospital-wide mortality of an RRT in which clinical judgment, in addition to vital signs criteria, was widely promoted as a key trigger for activation. All non-prisoner patients admitted to a tertiary referral public teaching hospital from 2003 through 2008 were included. A total of 77,021 admissions preintervention (2003 through 2005) and 79,013 admissions postintervention (2006 through 2008) were evaluate... Critical Care journals http://www.medworm.com/rss/comments.php?id=5415905 Tue, 15 Nov 2011 05:00:00 +0100 5415905 http://www.medworm.com/index.php?rid=5415908&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR266 Conclusions: Considering that liver stiffness cannot be validly measured in about 30% of ICU patients, transient elastography performed at ICU admission might be a useful tool to early identify liver dysfunction and predict mortality in critically ill patients at a medical ICU. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5415908 Mon, 14 Nov 2011 05:00:00 +0100 5415908 http://www.medworm.com/index.php?rid=5404047&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR265 IntroductionPrediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM(R)) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT. Methods: This retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, with an injury severity score [greater than or equal to]16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM analyses (extrinsically-activated test with tissue factor [EXTEM], intrinsically-activated test using ellagic acid [INTEM] and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytoch... Critical Care journals http://www.medworm.com/rss/comments.php?id=5404047 Fri, 11 Nov 2011 05:00:00 +0100 5404047 http://www.medworm.com/index.php?rid=5404046&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1006 Recent interest in transfusion management of trauma patients has heighted expectation in the role of blood component therapy in improving patient outcome. Unlike the importance of appropriate antifibrinolytic therapy, high quality evidence to define optimal transfusion support in supplementation with fibrinogen does not exist.. Current evidence comes mainly from case series and uncontrolled studies and does not support the superiority of one source of fibrinogen over another, nor the optimal schedule or dose for patient benefit. There are unanswered questions about safety, especially the effects on the risk of hospital-acquired venous thromboembolism, an important consideration in any therapy altering the haemostatic balance. Studies of cost-effectiveness have not been considered in resear... Critical Care journals http://www.medworm.com/rss/comments.php?id=5404046 Fri, 11 Nov 2011 05:00:00 +0100 5404046 http://www.medworm.com/index.php?rid=5394764&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR264 IntroductionMalabsorption, which is frequently under-diagnosed in critically ill patients, is clinically relevant with regard to nutritional balance and nutritional management. We aimed to validate the diagnostic accuracy of faecal weight as a biomarker for faecal loss and additionally to assess faecal macronutrient contents and intestinal absorption capacity in ICU patients. Methods: This was an observational pilot study in a tertiary mixed medical-surgical ICU in haemodynamically stable adult ICU patients, without clinically evident gastrointestinal malfunction. Faecal weight (g/d), faecal energy (by bomb calorimetry in kcal/d) and macronutrient content (fat, protein and carbohydrate in g/d) was measured. Diagnostic accuracy expressed in terms of test sensitivity, specificity, positive (... Critical Care journals http://www.medworm.com/rss/comments.php?id=5394764 Wed, 09 Nov 2011 05:00:00 +0100 5394764 http://www.medworm.com/index.php?rid=5394765&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F451 This study has succeeded to solve the problem that the choice and dose of antibiotics may have influenced the results. However, the authors should have considered the severity of CAP because adjunctive corticosteroid treatment should not be routinely administrated to patients with any severity of CAP. The target population for corticosteroid treatment should be clearly identified. In addition, the authors should consider lower doses and shorter periods of MPDN treatment in a future study. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5394765 Tue, 08 Nov 2011 05:00:00 +0100 5394765 http://www.medworm.com/index.php?rid=5394766&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1005 Real-time monitoring of mixed venous oxygen blood saturation (SvO2) or of central venous oxygen blood saturation is often used during resuscitation of septic shock. However, the meaning of these parameters is far from straightforward. In the present commentary, we emphasize that SvO2 - a global marker of tissue oxygen balance - can never be simplistically used as a marker of preload responsiveness, which is an intrinsic marker of cardiac performance. In some septic shock patients, because of profound hypovolemia or myocardial dysfunction, SvO2 can be low but obviously cannot alone indicate whether a fluid challenge would increase cardiac output. In other patients, because of a profound impairment of oxygen extraction capacities, SvO2 can be abnormally high even in patients who are still ab... Critical Care journals http://www.medworm.com/rss/comments.php?id=5394766 Mon, 07 Nov 2011 05:00:00 +0100 5394766 http://www.medworm.com/index.php?rid=5372544&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR263 Conclusions: We were unable to detect any association between the number of RBC transfusions or prolonged red cell storage and increased risk of DVT in medical or surgical ICU patients. Alternate explanations include a lack of sufficient events, patient factor interactions, a mixing of red cell storage times creating differential effects on DVT risk, and unmeasured confounders. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372544 Wed, 02 Nov 2011 04:00:00 +0100 5372544 http://www.medworm.com/index.php?rid=5372543&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2F1004 The Surviving Sepsis Campaign guidelines suggest targeting a mean arterial pressure of at least 65 mm Hg to maintain organ perfusion pressure during septic shock. However, the optimal mean arterial pressure can be higher in patients with a history of hypertension or other vascular comorbidities or in those with increased abdominal pressure. In a given individual, the adequate mean arterial pressure target can be difficult to define with the routine hemodynamic parameters (for example, cardiac output, central or mixed venous blood oxygen saturation, and urine output). Near-infrared spectroscopy and sidestream dark field imaging have emerged as promising technologies for monitoring the microcirculation at the bedside. These new methods could provide additional clues to help define the adequa... Critical Care journals http://www.medworm.com/rss/comments.php?id=5372543 Wed, 02 Nov 2011 04:00:00 +0100 5372543 http://www.medworm.com/index.php?rid=5372545&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F6%2FR262 Conclusions: Short people are less likely to receive LPV, which seems to explain the tendency of clinicians to adhere to LPV less strictly in women. Strategies to standardize application of LPV, independent of differences in height and severity of illness, are necessary. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372545 Tue, 01 Nov 2011 04:00:00 +0100 5372545 http://www.medworm.com/index.php?rid=5372547&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR261 Conclusions: We provide proof of principle in support of the efficacious use of PEGylated VT, a drug-like Tie2 receptor agonist, to counteract microvascular endothelial barrier dysfunction and reduce mortality in a clinically relevant murine sepsis model. Further studies are needed to pave the road for clinical application of this therapeutic concept. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372547 Mon, 31 Oct 2011 04:00:00 +0100 5372547 http://www.medworm.com/index.php?rid=5372546&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F449 Not applicable (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372546 Mon, 31 Oct 2011 04:00:00 +0100 5372546 http://www.medworm.com/index.php?rid=5372551&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR259 High-frequency oscillatory ventilation (HFOV) is associated with shorter length of mechanical ventilation and intensive care unit stay in neonates and infants with respiratory distress following congenital heart surgery. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372551 Fri, 28 Oct 2011 04:00:00 +0100 5372551 http://www.medworm.com/index.php?rid=5372550&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR260 Conclusions: Continuous HSS infusion adapted to close biological monitoring enables long-lasting control of natremia in TBI patients along with a decreased ICP without any rebound on infusion discontinuation. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372550 Fri, 28 Oct 2011 04:00:00 +0100 5372550 http://www.medworm.com/index.php?rid=5372549&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F1001 The Rapid Response System (RRS) concept is one of the first patient-centred and organisational-wide systems aimed at preventing deaths and serious adverse events. The widespread implementation of RRS forces us to examine previously underreported issues around the delivery of health care in hospitals. It is unique in that it operates across the usual silos in medicine, eg geographical sites; specialised teams caring for patients with multiorgan problems; and the avoidance of crossing boundaries for fear of offending the team primarily responsible for patient care. The study by Oglesby et al [1] argues for the use of a benchmark which reflects the care of a deteriorating patient within the organisation. The article studies the 'score to door time', ie the time from the first vital sign abnor... Critical Care journals http://www.medworm.com/rss/comments.php?id=5372549 Fri, 28 Oct 2011 04:00:00 +0100 5372549 http://www.medworm.com/index.php?rid=5372548&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F1003 Perioperative haemodynamic optimisation of high-risk surgical patients has been documented to improve both short and long term outcomes, as well as reducing the rate of postoperative complications. Evidence shows that cardiac output monitoring, fluid resuscitation and the use of inotropes, would seem to be the gold standard of care for these difficult surgical cases. However adopting these techniques and principles is not routine practice. Anaesthetists in Europe and the USA were surveyed to find out why: it appears that they understand the principles behind cardiac output monitoring, but rarely measure it directly or have protocols for utilising the result. If optimisation is to be adopted widely, education in both the theories and equipment will be required. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5372548 Fri, 28 Oct 2011 04:00:00 +0100 5372548 http://www.medworm.com/index.php?rid=5353936&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR258 Conclusions: The infusion of ANP or BNP may preserve postoperative renal function in cardiovascular surgery patients. A large, multicenter, prospective, randomized controlled trial will have to be performed, to assess the therapeutic potential of ANP or BNP in preventing and treating AKI in the cardiovascular surgical setting. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353936 Thu, 27 Oct 2011 04:00:00 +0100 5353936 http://www.medworm.com/index.php?rid=5353938&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR256 Conclusions: The observed variability in susceptibility to septic AKI in our models replicates that of human disease. Early abnormal host response accompanied by subsequent uncoupling between systemic and renal vascular resistance appear to be major determinants in the early phase of porcine septic AKI. Non-uniform and model related renal hemodynamic responses that are unpredictable from systemic changes should be taken into consideration when evaluating hemodynamic therapeutic interventions in septic AKI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353938 Wed, 26 Oct 2011 04:00:00 +0100 5353938 http://www.medworm.com/index.php?rid=5353937&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR257 Conclusions: The results suggest linear pharmacokinetics of dexmedetomidine up to the dose of 2.5 mu g/kg/hour. Despite the high dose and prolonged infusions, safety findings were as expected for dexmedetomidine and the patient population. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353937 Wed, 26 Oct 2011 04:00:00 +0100 5353937 http://www.medworm.com/index.php?rid=5353945&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F185 This study demonstrates that measurement of the pulmonary dead space fraction is superior to hypoxemia as an indicator of a favorable physiologic response to prone positioning in patients with severe acute respiratory distress syndrome (ARDS). These results add to the growing evidence supporting the clinical and research value of measuring pulmonary dead space in patients with ARDS and using this pulmonary physiologic end-point as one indicator of a favorable response to therapy. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353945 Tue, 25 Oct 2011 04:00:00 +0100 5353945 http://www.medworm.com/index.php?rid=5353944&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F233 The concept of acute-on-chronic liver failure (ACLF) has recently been introduced to describe a subset of patients with chronic liver disease presenting with profound deterioration of liver function and rapidly evolving multi-organ failure (MOF). ACLF is frequently accompanied by the development of severe inflammatory response syndrome (SIRS) and has a high mortality. To date, treatment options are limited and exclusively supportive. Over the last few years some insight has been generated in the pathophysiology of ACLF. A key role for the interaction of innate immune dysfunction, enhanced bacterial translocation from the gut and circulatory dysfunction has been proposed. In this respect, therapeutic strategies have been examined with variable success in experimental studies in animals and ... Critical Care journals http://www.medworm.com/rss/comments.php?id=5353944 Tue, 25 Oct 2011 04:00:00 +0100 5353944 http://www.medworm.com/index.php?rid=5353943&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR251 IntroductionIschemia/reperfusion after cardiopulmonary resuscitation (CPR) induces systemic inflammatory response and activation of endothelium and coagulation, resulting in a post-cardiac arrest syndrome. We analysed circulating (annexin V+) microparticles and their conjugates in resuscitated patients. Methods: 36 patients after successful resuscitation, 20 control patients with stable cardiac disease and 15 healthy subjects were included prospectively. Two blood samples were drawn, one immediately and one 24 hours after return of spontaneous circulation (ROSC) to detect (annexin V+) monocyte-derived microparticles (MMPs) or procoagulant (annexin V+) platelet-derived microparticles (PMPs) and conjugates of endothelial-derived (annexin V+) microparticles (EMPs) with monocytes (EMP-MC) or p... Critical Care journals http://www.medworm.com/rss/comments.php?id=5353943 Tue, 25 Oct 2011 04:00:00 +0100 5353943 http://www.medworm.com/index.php?rid=5353942&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR252 Conclusions: Overall, mRNA expressions of a panel of genes could represent promising candidates for the ex vivo evaluation of rIFN-gamma effect on monocyte functionality. This ex vivo translational research study demonstrates the potential of a mRNA-based approach to successfully monitor drug efficacy. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353942 Tue, 25 Oct 2011 04:00:00 +0100 5353942 http://www.medworm.com/index.php?rid=5353941&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR254 Conclusions: IL17A genetic variation is associated with altered susceptibility to Gram-positive infection and 28-day mortality of severe sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5353941 Tue, 25 Oct 2011 04:00:00 +0100 5353941 http://www.medworm.com/index.php?rid=5353940&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR255 IntroductionPost cardiac surgery vasodilatation is possibly related to a vasopressin deficiency that could be related to a chronic stimulation of the adeno-hypophysis. To assess vasopressin system activation, perioperative course of copeptin and vasopressin plasma concentrations have been studied in consecutive patients operated on cardiac surgery. Methods: 64 consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass were studied. Haemodynamic, laboratory and clinical data were recorded before and during cardiopulmonary bypass, and at the 8th post-operative hour (H8). At the same time, point's blood was withdrawn to determine plasma concentrations of arginine-vasopressin (AVP, radioimmunoassay) and copeptin (immunoluminometric assay). Post cardiac surgery vaso... Critical Care journals http://www.medworm.com/rss/comments.php?id=5353940 Tue, 25 Oct 2011 04:00:00 +0100 5353940 http://www.medworm.com/index.php?rid=5353939&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F1002 Post-ICU morbidity is an important issue for patients, families and the healthcare system. Elliott and colleagues outline the results from their recent and novel report of the very first home-based physiotherapy program to be tested in survivors of critical illness.The authors describe an explicit intervention including a self-instruction exercise manual, trainer visits and telephone follow-up, with excellent internal validity and yet no difference in outcome measures at 26 week follow-up. These results are discussed in the context of risk stratification/individual tailoring of post-ICU programs to patient/family needs and suggests that the collection of multiple simultaneous quantitative/qualitative outcome measures across functional, neuropsychological, caregiver and healthcare utilizati... Critical Care journals http://www.medworm.com/rss/comments.php?id=5353939 Tue, 25 Oct 2011 04:00:00 +0100 5353939 http://www.medworm.com/index.php?rid=5342270&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR249 Conclusions: A single-point BG assay based on a blood sample drawn at the sepsis onset, alone or in combination with Candida score, may guide the decision to start antifungal therapy early in patients at risk for Candida infection. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342270 Sat, 22 Oct 2011 04:00:00 +0100 5342270 http://www.medworm.com/index.php?rid=5342275&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR243 Conclusions: Our results demonstrate the prognostic role of NK cells in severe sepsis, evidencing a direct association of early blood counts of these cells with mortality. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342275 Fri, 21 Oct 2011 04:00:00 +0100 5342275 http://www.medworm.com/index.php?rid=5342274&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR244 Conclusions: Preserving spontaneous breathing can not only improve ventilatory function, but can also attenuate selected markers of VILI in the mechanically-ventilated healthy lung. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342274 Fri, 21 Oct 2011 04:00:00 +0100 5342274 http://www.medworm.com/index.php?rid=5342273&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR245 Conclusions: Unlike obesity, critical illness evokes adipose tissue accumulation of alternatively activated M2 macrophages, which have local anti-inflammatory and insulin sensitizing features. This M2 macrophage accumulation may contribute to the previously observed protective metabolic activity of adipose tissue during critical illness. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342273 Fri, 21 Oct 2011 04:00:00 +0100 5342273 http://www.medworm.com/index.php?rid=5342272&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR246 Conclusions: The increased HCS was associated with the MD qualitative assessment of enhanced continuity and efficiency after implanting a schedule change. The IP identified the potential for additional scheduling improvements. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342272 Fri, 21 Oct 2011 04:00:00 +0100 5342272 http://www.medworm.com/index.php?rid=5342271&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR247 Conclusions: We found that septic shock and abnormal fluctuations of plasma Ca2+ concentration represent significant risk factors for the development of CIPNM in critically ill patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342271 Fri, 21 Oct 2011 04:00:00 +0100 5342271 http://www.medworm.com/index.php?rid=5342278&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR242 Measuring the magnitude, duration and trend of changes in blood lactate concentration over time may be more useful in predicting outcome in critically ill patients than a single measurement taken on admission. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342278 Thu, 20 Oct 2011 04:00:00 +0100 5342278 http://www.medworm.com/index.php?rid=5342277&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F447 NA (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5342277 Thu, 20 Oct 2011 04:00:00 +0100 5342277 http://www.medworm.com/index.php?rid=5342276&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F448 A number of clinical studies confirmed the presence of persistant hypercytokinemia paraleling severe pandemic influenza, but none of these works have performed predictive models to analyze the relathionship between these cytokines and disease outcome. In this work we have reanalyzed our cohort of pandemic influenza critically ill patients recruited in 2009 and developed Cox regression models and survival curves. Interestingly, fatal influenza was associated by a disbalanced cuantitative response of a pro-Th17 factor (interlukin 17) and a anti-Th17 factor (G-CSF). While Th17 immune response it is thought to mediate protection against severe influenza disease, this article demonstrates for the first time the existence of an association between G-CSF and mortality and between IL-17 and increa... Critical Care journals http://www.medworm.com/rss/comments.php?id=5342276 Thu, 20 Oct 2011 04:00:00 +0100 5342276 http://www.medworm.com/index.php?rid=5329235&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR240 Conclusions: The majority of acute critically ill patients treated with enteral tobramycin as a component of SDD had traces of tobramycin in blood, especially those with severe shock, inflammation and subsequent acute kidney injury, suggesting loss of gut barrier and decreased renal removal. Unexpectedly, urinary tobramycin was above the therapeutic trough level in half of the patients. Nephrotoxicity could not be demonstrated. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5329235 Mon, 17 Oct 2011 04:00:00 +0100 5329235 http://www.medworm.com/index.php?rid=5329234&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F198 Increasing evidence suggests that the secondary phase of sepsis (that is, after the first proinflammatory hours) is characterized by the occurrence of a systemic failure of the immune system. In the most immunodepressed patients, therapies could be used to restore normal immune functions. However, biomarkers need to be developed to beforehand specifically identify these patients. Of these biomarkers, diminished monocyte HLA-DR expression has rapidly become the most popular. Herein, novel perspectives regarding monocyte HLA-DR assessed as a dynamic parameter in septic patients will be discussed in the context of a recently published study investigating daily evolution of monocyte HLA-DR with regard to 28 day-mortality after severe sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5329234 Mon, 17 Oct 2011 04:00:00 +0100 5329234 http://www.medworm.com/index.php?rid=5320270&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR239 Conclusions: The weight of evidence does not appear to support the clinical effectiveness of FFP for surgical/massive trauma patients, and suggests it can be detrimental. Perioperatively, fibrinogen concentrate was generally associated with improved outcome measures, although more high-quality, prospective studies are required before any definitive conclusions can be drawn. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5320270 Fri, 14 Oct 2011 04:00:00 +0100 5320270 http://www.medworm.com/index.php?rid=5320271&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR238 Conclusions: Incidence of severe metabolic or mixed acidemia in the critically ill was 6% in the present study and it was associated with a 57% mortality rate in the intensive care unit. In contradistinction with the initial acid-base parameters, the rapidity of acidemia recovery was an independent risk factor of mortality. Sodium bicarbonate prescription was very heterogeneous between ICUs. Further studies assessing specific treatments may be of interest in this population. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5320271 Thu, 13 Oct 2011 04:00:00 +0100 5320271 http://www.medworm.com/index.php?rid=5309579&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F446 No abstract for letter (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5309579 Thu, 13 Oct 2011 04:00:00 +0100 5309579 http://www.medworm.com/index.php?rid=5309580&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR237 Conclusions: The Utstein Template was feasible across international trauma centres for the majority of its data variables, with the exception of certain physiological and time variables. Major differences were found in the definition of survival and in AIS coding. The current results give a clear indication of the attainability of information and may serve as a stepping-stone towards creation of a European trauma registry. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5309580 Wed, 12 Oct 2011 04:00:00 +0100 5309580 http://www.medworm.com/index.php?rid=5309582&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F197 Activated protein C (APC), a physiological coagulation inhibitor, has been shown to reduce mortality in patients with severe sepsis. APC exerts pleiotropic cytoprotection by a mechanism that requires its interaction with endothelial cell protein C receptor (EPCR), and protease-activated receptor-1 (PAR-1) on target cells. In this issue, Perez-Casal and colleagues elegantly demonstrate that APC using its recombinant form (rhAPC) can communicate to target cells through release of microparticles (MPs), small membrane vesicles released from activated cells, to induce anti-apoptotic and anti-inflammatory properties that might participate in the improvement of patient outcome. Of interest is the fact that APC itself promotes the release of MPs from target cells including endothelial cells and mo... Critical Care journals http://www.medworm.com/rss/comments.php?id=5309582 Tue, 11 Oct 2011 04:00:00 +0100 5309582 http://www.medworm.com/index.php?rid=5309581&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F196 Trauma is a major cause of death worldwide, with some 30% of deaths associated with hemorrhage. Rapid control of bleeding in such patients is thus an essential aspect of trauma care. Recombinant human factor VIIa is sometimes used off-label in massively bleeding patients and has been demonstrated in two randomized trials to significantly reduce the need for blood transfusions. Whether this translates into improved outcomes has not been determined, most notably because mortality appears to be much lower than in the past as a result of improved general care of trauma patients. In this setting it may be increasingly difficult to demonstrate that any intervention can influence survival since the number of patients needed for sufficient power is so high and the duration needed for recruitment o... Critical Care journals http://www.medworm.com/rss/comments.php?id=5309581 Tue, 11 Oct 2011 04:00:00 +0100 5309581 http://www.medworm.com/index.php?rid=5309583&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR236 Conclusions: There was no difference in neurological favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5309583 Mon, 10 Oct 2011 04:00:00 +0100 5309583 http://www.medworm.com/index.php?rid=5301010&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F445 NA (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5301010 Mon, 10 Oct 2011 03:55:17 +0100 5301010 http://www.medworm.com/index.php?rid=5309584&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F231 Septic syndromes represent a major healthcare problem worldwide. Clinical and experimental evidences indicate that septic patients rapidly present with numerous compromised immune functions. Although flow cytometry (FCM) remains a relatively confidential diagnostic tool, it could be useful at every step of intensive care unit (ICU) patients' management. Indeed, neutrophil CD64 expression is a sensitive and specific tool for diagnosis of sepsis in adults, neonates and children. A diminished monocyte HLA-DR expression is a reliable marker for the development of monocyte anergy, prediction of secondary nosocomial infection and death in critically ill patients. Finally, the measurement of an increased CD4+CD25+CD127low regulatory T cell percentage may represent a reliable marker for the diagno... Critical Care journals http://www.medworm.com/rss/comments.php?id=5309584 Fri, 07 Oct 2011 04:00:00 +0100 5309584 http://www.medworm.com/index.php?rid=5301011&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2FR235 The time at which organ donation is discussed with relatives of patients with catastrophic brain injury in the Netherlands has changed over 20 years, maybe contributing to the high refusal rate. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5301011 Fri, 07 Oct 2011 04:00:00 +0100 5301011 http://www.medworm.com/index.php?rid=5280184&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F193 Recently, a multicenter randomized controlled trial (RCT) completed by D. James Cooper and colleagues indicates decompressive craniectomy (DC) may be associated with a worse functional outcome in patients with diffuse traumatic brain injury (TBI), despite DC can immediately and constantly reduce intracranial pressure (ICP). As this trial is well planned and with high quality, the unexpected result is meaningful. However, the evidence of the study is insufficient and the effect of DC in severe TBI is still indefinite. More multicentre RCTs are necessary to provide Class I evidence on the role of DC in the treatment of refractory raised ICP after severe TBI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5280184 Tue, 04 Oct 2011 03:31:36 +0100 5280184 http://www.medworm.com/index.php?rid=5280183&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F194 This study is a new step towards a study testing Coenzyme Q10 as a potential therapeutic agent for patients in septic shock. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5280183 Tue, 04 Oct 2011 03:31:36 +0100 5280183 http://www.medworm.com/index.php?rid=5267032&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F191 In hypoxemic patients needing fiberoptic bronchoscopy (FOB), noninvasive ventilation (NIV) has been used to prevent gas-exchange deterioration associated with FB, compensate for the increase in work of breathing occurring during FB, thus avoiding endotracheal intubation and its related complications. The application of NIV to allow FOB has been found of particular interest in the diagnosis of pneumonia in patients spontaneously breathing and who started NIV to assist FOB.In patients who were already receiving NIV for acute respiratory failure and who were scheduled to perform FOB, there were less information. In this issue of Critical Care, the study by Baumann and colleagues adds new information to this specific issue, addressing the feasibility and safety of FOB during NIV in patients wi... Critical Care journals http://www.medworm.com/rss/comments.php?id=5267032 Fri, 30 Sep 2011 04:00:00 +0100 5267032 http://www.medworm.com/index.php?rid=5267031&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F15%2F5%2F311 Conclusions: In patients with severe ARDS, early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness.Trial Registration: NCT00299650 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=5267031 Fri, 30 Sep 2011 04:00:00 +0100 5267031