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. Sat, 20 Mar 2010 15:51:42 +0100 http://www.medworm.com/index.php?rid=3381653&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F132 During the past decade, there have been an increasing number of studies investigating the precise role of T regulatory cells in human disease. First recognized for their ability to prevent autoimmunity, T regulatory cells control effector CD4+ and CD8+ T lymphocytes and innate immune cells by several different suppressive mechanisms, like cell to cell contact, secretion of inhibitory cytokines and cytolysis. This suppressive function of T regulatory cells could contribute in a similar way to the profound immune dysfunction seen in critical illness whether the latter is due to sepsis or severe injury. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3381653 Fri, 19 Mar 2010 00:00:00 +0100 3381653 http://www.medworm.com/index.php?rid=3381652&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F408 Noninvasive ventilation (NIV) is considered first-line intervention for different causes of acute respiratory failure (ARF). (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3381652 Fri, 19 Mar 2010 00:00:00 +0100 3381652 http://www.medworm.com/index.php?rid=3381654&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR41 Conclusions: Our study confirmed that a standard dose of 40 mg enoxaparin yielded sub- therapeutic levels of aFXa in critically ill patients. Higher doses resulted in better peak aFXa levels, with a ceiling effect observed at 60 mg. The present study seems to suggest inadequate dosage as one of the possible mechanisms for the higher failure rate of enoxaparin in ICU patients.Trial Registration: ISRCTN03037804 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3381654 Thu, 18 Mar 2010 00:00:00 +0100 3381654 http://www.medworm.com/index.php?rid=3377367&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR39 Conclusions: The use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury.Clinical Trial registration: NCT00935896 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3377367 Thu, 18 Mar 2010 00:00:00 +0100 3377367 http://www.medworm.com/index.php?rid=3377366&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR40 Conclusions: Volume expansion with low volume HES 130kDa/0.4 was not associated with AKI. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3377366 Thu, 18 Mar 2010 00:00:00 +0100 3377366 http://www.medworm.com/index.php?rid=3377365&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F306 No description available (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3377365 Thu, 18 Mar 2010 00:00:00 +0100 3377365 http://www.medworm.com/index.php?rid=3373015&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F407 N/A (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3373015 Wed, 17 Mar 2010 00:00:00 +0100 3373015 http://www.medworm.com/index.php?rid=3369345&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR34 Conclusions: In this model of ALI, the reduction of tidal re-aeration and hyperaeration during BIPAP+SBmean compared to PSV is not due to decreased nonaerated areas at end-expiration or different distribution of ventilation, but to lower tidal volumes during BIPAP+SBspont. The ratio between spontaneous to controlled breaths seems to play a pivotal role in reducing tidal re-aeration and hyperaeration during BIPAP+SBmean. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3369345 Tue, 16 Mar 2010 00:00:00 +0100 3369345 http://www.medworm.com/index.php?rid=3369344&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR35 This study examined the effect of eicosapentaenoic acid (EPA), an immunomodulator that can be safely administered to patients, on diaphragm force generation following endotoxin administration. Methods: Rats were administered the following (n=5/group): (a) saline, (b) endotoxin, 12 mg/kg IP, (c) endotoxin + EPA (1.0 g/kg/d), and (d) EPA alone. Diaphragms were removed and measurements made of the diaphragm force-frequency curve, calpain activation, caspase activation, and protein carbonyl levels. Results: Endotoxin elicited large reductions in diaphragm specific force generation (p (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3369344 Tue, 16 Mar 2010 00:00:00 +0100 3369344 http://www.medworm.com/index.php?rid=3369343&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR36 The objectives were to characterize alveolar fluid clearance (AFC) in pigs with normal lungs and to analyze the effect of immediate application of positive end-expiratory pressure (PEEP). Methods: Animals (n=25) were mechanically ventilated and divided into four groups: small edema (SE) group, producing pulmonary edema (PE) by intratracheal instillation of 4 ml/kg of saline solution; small edema with PEEP (SE+PEEP) group, same as previous but applying PEEP of 10 cmH2O; large edema (LE) group, producing PE by instillation of 10 ml/kg of saline solution; large edema with PEEP (LE+PEEP) group, same as LE group but applying PEEP of 10 cmH2O. AFC was estimated from differences in extravascular lung water values obtained by transpulmonary thermodilution method. Results: At 1 h, AFC was 19.4% in ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3369343 Tue, 16 Mar 2010 00:00:00 +0100 3369343 http://www.medworm.com/index.php?rid=3369346&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR33 Conclusions: Serum leptin correlates well with serum level of IL-6 and TNF-alpha. Leptin helps to differentiate SIRS from non-SIRS patients. CRP is a classic marker of sepsis but is of late onset. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3369346 Mon, 15 Mar 2010 00:00:00 +0100 3369346 http://www.medworm.com/index.php?rid=3365555&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR31 IntroductionThe aims of our study were to evaluate the impact of increased intra-abdominal pressure (IAP) on central nervous system (CNS) cytokines (interleukin 6 and tumor necrosis factor), lactate and perfusion pressures, testing the hypothesis that intra-abdominal hypertension (IAH) may possibly lead to CNS ischemia. Methods: Fifteen pigs were studied. Helium pneumoperitoneum was established and IAP was increased initially at 20mmHg and subsequently at 45mmHg, which was finally followed by abdominal desufflation. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNFa) and lactate were measured in the cerebrospinal fluid (CSF) and intracranial (ICP), intraspinal (ISP), cerebral perfusion (CPP) and spinal perfusion (SPP) pressures recorded. Results: Increased IAP (20mmHg) was followed by... Critical Care journals http://www.medworm.com/rss/comments.php?id=3365555 Mon, 15 Mar 2010 00:00:00 +0100 3365555 http://www.medworm.com/index.php?rid=3369347&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F303 No description available (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3369347 Fri, 12 Mar 2010 00:00:00 +0100 3369347 http://www.medworm.com/index.php?rid=3361743&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F130 Since the inception of blood banking, refinements in laboratory processes have allowed for progressively longer storage times of red blood cells (RBCs). Whilst advantageous for the logistics of stock management, the clinical impact of the duration of RBC storage prior to transfusion remains uncertain, and a topic of growing interest. In this issue, Ranucci and colleagues1 report an adverse outcome in infants receiving "older" blood during cardiopulmonary bypass (CPB).The current standard RBC storage time of up to 42 days is not based upon a demonstrable therapeutic benefit, but instead on the observed return of 70% of the viable transfused RBCs at 24 hours after storage for 42 days or less. The structural, biochemical and immunological changes that RBCs undergo during storage are well desc... Critical Care journals http://www.medworm.com/rss/comments.php?id=3361743 Fri, 12 Mar 2010 00:00:00 +0100 3361743 http://www.medworm.com/index.php?rid=3353298&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F131 The rapid economic growth in parts of the developing world is being accompanied by an expansion of critical care. Hurdles to expansion include lack of critical care training for healthcare workers. This is coupled with a need for a huge number of healthcare workers due to the high populations of countries such as China and India. Intensivists in the developed world can and should help. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3353298 Thu, 11 Mar 2010 00:00:00 +0100 3353298 http://www.medworm.com/index.php?rid=3349370&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F128 Lipid emulsions based on soybean oil have been an integral part of parenteral nutrition supplying n-6 fatty acids with possible negative effects in critically ill patients. Newer lipid emulsions supply less n-6 fatty acids. In addition, fish oil-based lipids may be included into the lipid component of parenteral nutrition. While clinical benefits of lipids emulsions with a reduced fraction in n-6 lipids and the addition of fish oil have been described in post-operative patients data are less clear in critically ill or septic patients. Recent data suggests that beneficial effects may be achieved when used early but clearly more data are needed to come to a definitive conclusion. This commentary will highlight current data in critically ill and septic patients and the use of fish oil as a pa... Critical Care journals http://www.medworm.com/rss/comments.php?id=3349370 Wed, 10 Mar 2010 00:00:00 +0100 3349370 http://www.medworm.com/index.php?rid=3349369&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F129 Goal-directed therapy (GDT) can be a vague term, meaning different things to different people, and depending on the clinical environment, sometimes even different things to the same person. It can refer to perioperative fluid management, or clinicians driving oxygen delivery to supramaximal values, early treatment of sepsis in the emergency department, and even to restriction of perioperative crystalloids with the goal of maintaining pre-admission body weight. Understandably, strong opinions range from GDT being considered essential for perioperative care, to it being completely ineffective in critically ill patients. This commentary aims to further position the excellent review by Lees et al in the context of the critical care and perioperative setting. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3349369 Wed, 10 Mar 2010 00:00:00 +0100 3349369 http://www.medworm.com/index.php?rid=3349371&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F208 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3349371 Tue, 09 Mar 2010 00:00:00 +0100 3349371 http://www.medworm.com/index.php?rid=3345686&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F209 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345686 Tue, 09 Mar 2010 00:00:00 +0100 3345686 http://www.medworm.com/index.php?rid=3345685&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F210 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345685 Tue, 09 Mar 2010 00:00:00 +0100 3345685 http://www.medworm.com/index.php?rid=3345684&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F211 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345684 Tue, 09 Mar 2010 00:00:00 +0100 3345684 http://www.medworm.com/index.php?rid=3345683&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F212 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345683 Tue, 09 Mar 2010 00:00:00 +0100 3345683 http://www.medworm.com/index.php?rid=3345682&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F213 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345682 Tue, 09 Mar 2010 00:00:00 +0100 3345682 http://www.medworm.com/index.php?rid=3345681&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F214 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345681 Tue, 09 Mar 2010 00:00:00 +0100 3345681 http://www.medworm.com/index.php?rid=3345680&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F215 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345680 Tue, 09 Mar 2010 00:00:00 +0100 3345680 http://www.medworm.com/index.php?rid=3345679&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F216 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345679 Tue, 09 Mar 2010 00:00:00 +0100 3345679 http://www.medworm.com/index.php?rid=3345678&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F217 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3345678 Tue, 09 Mar 2010 00:00:00 +0100 3345678 http://www.medworm.com/index.php?rid=3334126&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F124 The accuracy of the arterial pressure-based cardiac output (APCO) FloTrac-Vigileo(R) system remains unacceptably low during haemodynamic instability. Data show that the measurement of cardiac output (CO) is strongly influenced by changes in factors that affect arterial blood pressure (ABP) - e.g., vascular tone and compliance, and the arterial site - independently of true changes in CO. Although in theory the autocalibration algorithm of FloTrac-Vigileo(R) should adjust for those changes, the model under- (or over-) compensates for prominent increases (or decreases) in vascular tone and compliance, making the system largely dependent on changes in ABP. These limitations make FloTrac-Vigileo(R) accurate only in stable haemodynamic conditions and until more robust algorithms and further vali... Critical Care journals http://www.medworm.com/rss/comments.php?id=3334126 Fri, 05 Mar 2010 00:00:00 +0100 3334126 http://www.medworm.com/index.php?rid=3334125&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR28 Conclusions: Overall, the FVL mutation did not appear to increase the risk of admission due to severe invasive infections. Nevertheless, in the subgroup of patients admitted to intensive care an increased risk and a poorer long-term outcome for individuals with critical illness were observed for FVL mutation carriers. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3334125 Fri, 05 Mar 2010 00:00:00 +0100 3334125 http://www.medworm.com/index.php?rid=3341732&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F406 None (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3341732 Thu, 04 Mar 2010 00:00:00 +0100 3341732 http://www.medworm.com/index.php?rid=3330390&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F217 Clinicians depend on recognizing particular critical illness (such as sepsis and cardiac failure) from patterns of vital signs. The relationship between a vital sign pattern and a specific condition is explored. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3330390 Thu, 04 Mar 2010 00:00:00 +0100 3330390 http://www.medworm.com/index.php?rid=3330389&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D None (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3330389 Thu, 04 Mar 2010 00:00:00 +0100 3330389 http://www.medworm.com/index.php?rid=3330388&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR27 Conclusions: The incidence of Gram-negative bacteremia was significantly higher in bacteremic ICU patients with septic shock than in those with sepsis or severe sepsis. Furthermore, CRP and IL-6 levels were significantly higher in Gram-negative bacteremia than in Gram-positive bacteremia. These findings suggest that differences in host responses and virulence mechanisms of different pathogenic microorganisms should be considered in treatment of bacteremic patients, and that new countermeasures beyond conventional antimicrobial medications are urgently needed. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3330388 Thu, 04 Mar 2010 00:00:00 +0100 3330388 http://www.medworm.com/index.php?rid=3317707&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2F126 This study contributes to the growing evidence that diabetes in itself is not a risk factor for ICU mortality, through mechanisms which are not yet fully understood. On the other hand, patients with diabetes seem not to benefit from tight glycemic control during their ICU stay. Different treatment approaches may be needed for patients with diabetes and patients with stress hyperglycemia. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3317707 Mon, 01 Mar 2010 00:00:00 +0100 3317707 http://www.medworm.com/index.php?rid=3317706&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F2%2FR26 IntroductionMechanical ventilation of patients may be accomplished by either translaryngeal intubation or tracheostomy. While numerous ICU studies have compared various outcomes between the two techniques, there is no definitive consensus that tracheostomy is superior. Comparable studies have not been performed in a respiratory care center (RCC) setting. Methods: This was a retrospective observational study of 985 tracheostomy and 227 translaryngeal intubated patients who received treatment in a 24-bed RCC between November 1999 and December 2005. Treatment and mortality outcomes were compared between tracheostomized and translaryngeal intubated patients, and the factors associated with positive outcomes in all patients were determined. Results: Duration of RCC (22 vs. 14 days) and total ho... Critical Care journals http://www.medworm.com/rss/comments.php?id=3317706 Mon, 01 Mar 2010 00:00:00 +0100 3317706 http://www.medworm.com/index.php?rid=3305744&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F125 This study found that an endogenous patient characteristic, the personality trait pessimism, was associated with posttraumatic stress and depressive symptoms. Myhren et al.'s study sheds light on potential predictors of psychopathology in critical illness survivors as well as stimulates directions for future research to address these complex problems. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3305744 Thu, 25 Feb 2010 00:00:00 +0100 3305744 http://www.medworm.com/index.php?rid=3305743&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F205 You are director of a large multi-disciplinary ICU. You have recently read that hospital-wide antibiotic stewardship programs have the potential to improve the quality and safety of care, reduce the emergence of multi-drug resistant organisms and overall costs. You are considering starting one of these programs in your ICU, but are concerned about the associated infrastructure costs. You are debating whether it is worth bringing the concept forward to your hospital's administration to consider investing in. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3305743 Thu, 25 Feb 2010 00:00:00 +0100 3305743 http://www.medworm.com/index.php?rid=3305742&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F206 Critical care medicine began in China mainland in early 1980s. After almost 30 years of efforts, it has been recognized as a specialty very recently. However, limited data suggest that critical care resources, especially ICU beds, are inadequate compared with those of developed countries. National critical care societies work together to set up good practice standards, and improve academic level with scientific meetings, education programs, and training courses. Critical care research in China mainland begins to evolve, with a great potential for improvement. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3305742 Thu, 25 Feb 2010 00:00:00 +0100 3305742 http://www.medworm.com/index.php?rid=3301023&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR25 IntroductionHigher lactate concentrations within the normal reference range ("relative hyperlactatemia") are not considered clinically significant. We tested the hypothesis that relative hyperlactatemia is independently associated with an increased risk of hospital death. Methods: Retrospective observational study of prospectively obtained intensive care database of 7155 consecutive critically ill patients admitted to the Intensive Care Units (ICUs) of four Australian university hospitals. We assessed the relationship between ICU admission (LacADM), maximal (LacMAX) and time-weighted (LacTW) lactate levels and hospital outcome in all patients and in those patients whose LacADM (n=3964), LacMAX (n=2511) and LacTW (n=4584) lactate was under 2 mmol.L-1 (relative hyperlactatemia). Results: We ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3301023 Wed, 24 Feb 2010 00:00:00 +0100 3301023 http://www.medworm.com/index.php?rid=3297513&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR23 Conclusions There is no good evidence from controlled studies for a positive effect of triple-H or its separate components on CBF in SAH patients. In uncontrolled studies, hypertension seems to be more effective in increasing CBF than hemodilution or hypervolemia. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3297513 Mon, 22 Feb 2010 00:00:00 +0100 3297513 http://www.medworm.com/index.php?rid=3297512&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR24 Conclusions: RAS is activated in clinical severe sepsis. Systemic RAS mediators correlate with measures of microvascular dysregulation and with organ failure. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3297512 Mon, 22 Feb 2010 00:00:00 +0100 3297512 http://www.medworm.com/index.php?rid=3293750&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F117 Certain noble gases, though inert, exhibit remarkable biological properties. Notably xenon and argon provide neuroprotection in animal models of central nervous system injury. In this issue of Critical Care, Loetscher and colleagues have provided further evidence that argon may have therapeutic properties for neuronal toxicity by demonstrating protection against both traumatic and oxygen-glucose deprivation (OGD) injury of organotypic hippocampal cultures in vitro. Their data are of interest as argon is more abundant, and therefore cheaper, than xenon (that is currently in clinical trials for perinatal hypoxic-ischemic brain injury; TOBYXe NCT00934700). We eagerly await in vivo data to complement the promising in vitro data hailing argon neuroprotection (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3293750 Mon, 22 Feb 2010 00:00:00 +0100 3293750 http://www.medworm.com/index.php?rid=3286695&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F123 White et al have shown in a randomised trial comparing early enteral feeding by gastric and post-pyloric routes that gastric feeding is possible and efficient in the vast majority of critically ill patients. But their conclusion that gastric is equivalent to post-pyloric is only true in the least severe patients though. Considering the extra work load and costs, post-pyloric is now clearly indicated in case of gastric feeding failure. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3286695 Fri, 19 Feb 2010 00:00:00 +0100 3286695 http://www.medworm.com/index.php?rid=3286694&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR22 IntroductionLactic acidosis can develop during biguanide (metformin and phenformin) intoxication, possibly as a consequence of mitochondrial dysfunction. To verify this hypothesis, we investigated whether body oxygen consumption (VO2), that primarily depends on mitochondrial respiration, is depressed in patients with biguanide intoxication. Methods: Multicentre retrospective analysis of data collected from 24 patients with lactic acidosis (pH 6.93+/-0.20; lactate 18+/-6 mM at hospital admission) due to metformin (n=23) or phenformin (n=1) intoxication. In 11 patients, VO2 was computed as the product of simultaneously recorded arterio-venous difference in O2 content [C(a-v)O2] and cardiac index (CI). In 13 additional cases, C(a-v)O2, but not CI, was available. Results: On day 1, VO2 was mar... Critical Care journals http://www.medworm.com/rss/comments.php?id=3286694 Fri, 19 Feb 2010 00:00:00 +0100 3286694 http://www.medworm.com/index.php?rid=3278976&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F120 In this month's issue of Critical Care, Determann and colleagues[1] report the results of a randomized controlled trial comparing the effects of mechanical ventilation (MV) with two tidal volumes (6 vs. 10 ml/kg predicted body weight) on cytokines levels in the lung lavage fluid and plasma, as a surrogate for early identification of acute lung injury (ALI) and/or the acute respiratory distress syndrome (ARDS). The study was stopped early after an interim analysis -when 150 patients were enrolled- showed that the incidence of ALI/ARDS according to current definition was 10.9% higher in the 10 ml/kg group, although duration of MV and mortality was similar in both groups. We would like to examine these interesting results upon a brief historical perspective and discuss the limitations and imp... Critical Care journals http://www.medworm.com/rss/comments.php?id=3278976 Tue, 16 Feb 2010 00:00:00 +0100 3278976 http://www.medworm.com/index.php?rid=3275072&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D In this month's issue of Critical Care, Determann and colleagues[1] report the results of a randomized controlled trial comparing the effects of mechanical ventilation (MV) with two tidal volumes (6 vs. 10 ml/kg predicted body weight) on cytokines levels in the lung lavage fluid and plasma, as a surrogate for early identification of acute lung injury (ALI) and/or the acute respiratory distress syndrome (ARDS). The study was stopped early after an interim analysis -when 150 patients were enrolled- showed that the incidence of ALI/ARDS according to current definition was 10.9% higher in the 10 ml/kg group, although duration of MV and mortality was similar in both groups. We would like to examine these interesting results upon a brief historical perspective and discuss the limitations and imp... Critical Care journals http://www.medworm.com/rss/comments.php?id=3275072 Tue, 16 Feb 2010 00:00:00 +0100 3275072 http://www.medworm.com/index.php?rid=3275071&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F121 Data continue to emerge demonstrating the poor quality of life of intensive care unit (ICU) survivors in the months and years following critical illness. In a recent issue of Critical Care, Cuthbertson and colleagues present new data on quality of life from a cohort of ICU survivors who were followed for five years. They found that survivors had poor physical quality of life and low quality adjusted life-years in comparison to age-adjusted norms, describing the long-term impact of critical illness as similar to a co-morbidity. Studies are now needed that seek to identify potentially modifiable factors both during and following an ICU admission to allow for eventual improvement in long-term morbidity. Such studies will likely need to incorporate extensive planning for data collection, as we... Critical Care journals http://www.medworm.com/rss/comments.php?id=3275071 Tue, 16 Feb 2010 00:00:00 +0100 3275071 http://www.medworm.com/index.php?rid=3275070&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F122 A small study in patients with severe sepsis suggested that insulin infused to normalize blood glucose levels increased forearm flow. This clinical observation supports the effect of insulin on the endothelium, as previously shown by in vitro studies and by in vivo animal models of critical illness, but the clinical consequences remain unclear. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3275070 Tue, 16 Feb 2010 00:00:00 +0100 3275070 http://www.medworm.com/index.php?rid=3278977&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F204 Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people.Therapeutic hypothermia has been shown to improve outcome after cardiac arrest, consequently the European Resuscitation Council and American Heart Association guidelines recommend the use of hypothermia in these patients. Hypothermia is also thought to improve neurological outcome after neonatal birth asphyxia. Cardiac arrest and neonatal asphyxia patient populations present to health care services rapidly and without posing ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3278977 Mon, 15 Feb 2010 00:00:00 +0100 3278977 http://www.medworm.com/index.php?rid=3275075&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2F Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people.Therapeutic hypothermia has been shown to improve outcome after cardiac arrest, consequently the European Resuscitation Council and American Heart Association guidelines recommend the use of hypothermia in these patients. Hypothermia is also thought to improve neurological outcome after neonatal birth asphyxia. Cardiac arrest and neonatal asphyxia patient populations present to health care services rapidly and without posing ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3275075 Mon, 15 Feb 2010 00:00:00 +0100 3275075 http://www.medworm.com/index.php?rid=3275074&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR19 Conclusions: These data argue against a determinant role of Tregs in inflammatory response and outcome during shock states. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3275074 Mon, 15 Feb 2010 00:00:00 +0100 3275074 http://www.medworm.com/index.php?rid=3275073&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR20 Conclusions: Interval antibiotic therapy is associated with the presence of MDR bacteria. Not all regimens proposed by Infectious Disease Society of America and the Surgical Infection Society guidelines for PP can provide an acceptable rate of adequacy. Monotherapy with imipenem/cilastin is suitable for EA only in absence of this risk factor for MDR. For other patients, only antibiotic combinations may achieve high adequacy rates. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3275073 Mon, 15 Feb 2010 00:00:00 +0100 3275073 http://www.medworm.com/index.php?rid=3272325&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F118 Crystalloid and colloid solutions are used for resuscitation of the critically ill. One option, which is widely used today, are different preparations of HES. However, the safety of HES regarding impairment of blood coagulation remains incompletely elucidated and limits its clinical use. Understanding mechanisms and potential differences between low-molecular and low substituted HES and other HES solutions seems clinically relevant. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3272325 Mon, 15 Feb 2010 00:00:00 +0100 3272325 http://www.medworm.com/index.php?rid=3272324&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F119 The induced production of pro- and anti-inflammatory cytokines is considered important for the development of sepsis and its sequelae. Polymorphisms in the IL-10 gene promoter could influence its expression and sepsis susceptibility. Results obtained by Dr. Ling and colleagues demonstrated that -1082A allele was significantly associated with lower LPS-induced IL-10 production in an allele-dose dependent fashion. They also showed that this polymorphism was significantly associated with sepsis development after major trauma. These and other researches data clearly demonstrated that -1082 A/G polymorphism in the IL-10 gene promoter, has an important impact on susceptibility of sepsis and sepsis outcome. differences in susceptibility to sepsis development. Polymorphisms in the regulatory regio... Critical Care journals http://www.medworm.com/rss/comments.php?id=3272324 Mon, 15 Feb 2010 00:00:00 +0100 3272324 http://www.medworm.com/index.php?rid=3272323&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F204 Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people.Therapeutic hypothermia has been shown to improve outcome after cardiac arrest, consequently the European Resuscitation Council and American Heart Association guidelines recommend the use of hypothermia in these patients. Hypothermia is also thought to improve neurological outcome after neonatal birth asphyxia. Cardiac arrest and neonatal asphyxia patient populations present to health care services rapidly and without posing ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3272323 Mon, 15 Feb 2010 00:00:00 +0100 3272323 http://www.medworm.com/index.php?rid=3272322&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F405 Central venous line insertion is a routine procedure in intensive care unit. But intensivists should be aware of the possibility of rare anatomical variants. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3272322 Mon, 15 Feb 2010 00:00:00 +0100 3272322 http://www.medworm.com/index.php?rid=3272321&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR18 Conclusions: In high-risk patients undergoing major abdominal surgery, implementation of an intraoperative goal-directed hemodynamic optimization protocol using the FloTrac/Vigileo device was associated with a reduced length of hospital stay and a lower incidence of complications compared to a standard management protocol.Clinical trial registration information: Unique identifier: NCT00549419 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3272321 Mon, 15 Feb 2010 00:00:00 +0100 3272321 http://www.medworm.com/index.php?rid=3265931&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR17 Conclusions: The patterns of brain injury in early diffusion-weighted imaging (DWI) ([less than or equal to] 5 days after resuscitation) and the quantitative measurement of regional ADC may be useful for predicting the clinical outcome of comatose patients after cardiac arrest. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3265931 Fri, 12 Feb 2010 00:00:00 +0100 3265931 http://www.medworm.com/index.php?rid=3261808&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F115 The great majority of infections caused by the pandemic variant of the influenza virus (nvH1N1) are self-limited, but a small percentage of patients develop severe symptoms requiring hospitalization. Bermejo-Martin and colleagues have presented a pilot study describing the differences in the early immune response for patients both mildly and severely infected with nvH1N1. Patients who develop severe symptoms after nvH1N1 infection showed Th1 and Th17 "hypercytokinemia", compared to mildly infected patients and healthy controls. The mediators involved with the Th1 and Th17 profiles are known to be involved in antiviral, pro-inflammatory and autoimmune responses. This is the first work reporting the association of a pro-inflamatory immune response to a severe pandemic infection although it i... Critical Care journals http://www.medworm.com/rss/comments.php?id=3261808 Thu, 11 Feb 2010 00:00:00 +0100 3261808 http://www.medworm.com/index.php?rid=3261807&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F116 Extracorporeal membrane oxygenation (ECMO) is widely accepted as a rescue therapy in patients with acute life-threatening hypoxemia in the course of severe acute respiratory distress syndrome (ARDS). However, possible side effects and complications are considered to limit beneficial outcome effects. Therefore, widening indications with the aim to reduce ventilator induced lung injury (VILI) is still controversial. Consequently, technological progress is an important strategy. Miniaturized ECMO systems are believed to simplify handling and reduce side effects and complications. Mueller and co-workers evaluated such a small-sized device in 60 patients with severe ARDS. Conceptually, they herewith accomplished both treatment of severe hypoxemia and reduction of VILI. As a result, feasibility,... Critical Care journals http://www.medworm.com/rss/comments.php?id=3261807 Thu, 11 Feb 2010 00:00:00 +0100 3261807 http://www.medworm.com/index.php?rid=3257812&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F106 Many advances have been made in the understanding and treatment of burns. Advances in burn surgery and critical care have decreased mortality and morbidity. Survival from severe burns is not longer the exception, but unfortunately death still occurs. Williams and colleagues have determined in their recent paper the predominant causes of death in order to develop new treatment avenues and future trajectories suitable to increase survival and overall outcome. A lot of burn deaths may be preventable with better airway management and a more precise and adequate volume management, but the leading cause of death in patients suffering from severe burns, that have to be faced, is sepsis. Sepsis due to multi-drug resistant organisms will continue to impede efforts to increase survival and new stra... Critical Care journals http://www.medworm.com/rss/comments.php?id=3257812 Wed, 10 Feb 2010 00:00:00 +0100 3257812 http://www.medworm.com/index.php?rid=3257811&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F107 Acute kidney injury is commonly encountered and in the critically ill treatment is principally supportive. A recent large, multicenter study has used retrospective analysis to try and identify patient outcomes when commencing renal replacement therapy using conventional biochemical and physiological markers. The authors have also made an attempt to decipher when to commence renal replacement therapy. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3257811 Wed, 10 Feb 2010 00:00:00 +0100 3257811 http://www.medworm.com/index.php?rid=3257810&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F114 Acute respiratory failure is a life threatening complication in cancer patients. During neutropenia, patients are at high risk for bacterial pneumonia or invasive fungal infections, when neutropenia is prolonged. A high proportion of patients in whom neutropenia had been complicated by pneumonia will present with substantial respiratory deterioration during neutropenia recovery. Patients with fungal pneumonia and those receiving G-CSF to shorten neutropenia duration may be at higher risk for this ALI/ARDS during neutropenia recovery. Routine screening of patient's risk factors is crucial since first symptoms of ARDS may occur before biological leukocyte recovery. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3257810 Wed, 10 Feb 2010 00:00:00 +0100 3257810 http://www.medworm.com/index.php?rid=3257813&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR15 Conclusions: Many biomarkers have been evaluated for use in sepsis. Most of the biomarkers had been tested clinically, primarily as prognostic markers in sepsis; relatively few have been used for diagnosis. None has sufficient specificity or sensitivity to be routinely employed in clinical practice. PCT and CRP have been most widely used, but even these have limited ability to distinguish sepsis from other inflammatory conditions or to predict outcome. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3257813 Tue, 09 Feb 2010 00:00:00 +0100 3257813 http://www.medworm.com/index.php?rid=3253583&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR14 IntroductionTo study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge. Methods: Of 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was [greater than or equal to] 35. Case level of HADS-Anxiety or Depression was [greater than or equal to] 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low... Critical Care journals http://www.medworm.com/rss/comments.php?id=3253583 Mon, 08 Feb 2010 00:00:00 +0100 3253583 http://www.medworm.com/index.php?rid=3250334&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F112 Acute kidney injury (AKI) is now well recognized as an independent risk factor for increased morbidity and mortality particularly when dialysis is needed. The wide variation in dialysis utilization contributes to a lack of consensus on what parameters should guide the decision to start dialysis. While the association of early initiation of dialysis with survival benefit has been first demonstrated four decades ago, few studies in the modern era of dialysis have addressed time of dialysis initiation. Although listed as one of the top priorities in research on AKI, timing of dialysis initiation was has not been included as a factor in any of the large, randomized controlled trials in this area. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3250334 Mon, 08 Feb 2010 00:00:00 +0100 3250334 http://www.medworm.com/index.php?rid=3250333&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F113 : The importance of adrenal function to survival in critically ill patients has been established; however, identifying the best method to diagnose adrenal insufficiency has been problematic. Multiple methods of determining adrenal function have been developed, each with its advantages and disadvantages. Serum free cortisol levels are probably the most accurate though obtaining this result is technically demanding. Cohen et al (1) investigated the feasibility of measuring tissue cortisol levels in burn patients, and investigated if tissue cortisol levels could be used as a surrogate for plasma free cortisol levels. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3250333 Mon, 08 Feb 2010 00:00:00 +0100 3250333 http://www.medworm.com/index.php?rid=3250332&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F203 In patients with community acquired pneumonia (CAP), traditional criteria of infection based on clinical signs and symptoms, clinical scoring systems, and general inflammatory indicators (e.g. leukocytosis, fever, C -reactive protein and blood cultures), are often of limited clinical value and remain an unreliable guide to etiology, optimal therapy and prognosis. Procalcitonin (PCT) is superior to other commonly used markers in its specificity for bacterial infection (allowing alternative diagnoses to be excluded), as an indicator of disease severity and risk of death, and mainly as a guide to the necessity for antibiotic therapy. It can therefore be viewed as a diagnostic, prognostic, and perhaps even "theragnostic" test. It more closely matches the criteria for usefulness than other cand... Critical Care journals http://www.medworm.com/rss/comments.php?id=3250332 Mon, 08 Feb 2010 00:00:00 +0100 3250332 http://www.medworm.com/index.php?rid=3250331&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F404 None (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3250331 Mon, 08 Feb 2010 00:00:00 +0100 3250331 http://www.medworm.com/index.php?rid=3242780&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F302 The Critical Care Canada Forum was held in Toronto, Canada from October 25-28 2009. The conference, which focuses on the care of critically ill patients wherever the patients are located, was attended by 879 delegates and featured 197 separate presentations, including several as yet unpublished trials. The hot topic this year was planning for the impact of a worldwide outbreak of H1N1 influenza on critical care systems, but the conference also covered a broad range of critical care interventions including mechanical ventilation, sedation and analgesia, renal replacement therapy, and extracorporeal membrane oxygenation. Herein we summarize just a few of the many exciting clinical trials and plenary topics presented at the conference. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3242780 Fri, 05 Feb 2010 00:00:00 +0100 3242780 http://www.medworm.com/index.php?rid=3238618&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F111 Postoperative intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients operated on for severe abdominal trauma, secondary peritonitis or ruptured abdominal aortic aneurysm. IAH may progress to abdominal compartment syndrome (ACS) with new onset organ dysfunction. Early recognition of IAH and interventions that prevent the development of ACS may preserve vital organ functions and increase the probability of survival. The best method to prevent postoperative ACS is to leave the abdomen open during the operation. Decision to leave the abdomen open is usually based on surgeon's judgment without intra-abdominal pressure (IAP) measurements during the operation. Because a significant morbidity and mortality is associated also with the open abdomen, the measurement of... Critical Care journals http://www.medworm.com/rss/comments.php?id=3238618 Thu, 04 Feb 2010 00:00:00 +0100 3238618 http://www.medworm.com/index.php?rid=3238617&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F403 na (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3238617 Thu, 04 Feb 2010 00:00:00 +0100 3238617 http://www.medworm.com/index.php?rid=3234674&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR11 Conclusions: Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management. Physicians wishing to practice glycemic control in their critically ill pediatric patients may want to consider adopting center-wide uniform approaches to improve safety and efficacy of treatment. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3234674 Wed, 03 Feb 2010 00:00:00 +0100 3234674 http://www.medworm.com/index.php?rid=3234675&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR10 Conclusions: Here we show for the first time the feasibility of clustering physiological measurements to identify clinically relevant patient states after trauma. These results demonstrate that hierarchical clustering techniques can be useful for visualizing complex multivariate data and may provide new insights for the care of critically injured patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3234675 Tue, 02 Feb 2010 00:00:00 +0100 3234675 http://www.medworm.com/index.php?rid=3219401&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F109 Patients requiring tracheostomies tend to have longer length of stay due to their underlying disease. After a thorough literature search, Garrubba and colleagues (1) found only 3 studies assessing the impact of multidisciplinary teams (MDT) on tracheostomy patients on the ward. One consistent observation was the decreased time to decannulation after institution of MDT care when compared to historical controls. Although a large prospective randomized trial is desirable before MDT is recommended, many institutions may have already formed a team approach to provide coordinated care resulting in improved outcome and length of stay. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3219401 Fri, 29 Jan 2010 00:00:00 +0100 3219401 http://www.medworm.com/index.php?rid=3215445&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F301 Book Review -> Abstract? (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3215445 Thu, 28 Jan 2010 00:00:00 +0100 3215445 http://www.medworm.com/index.php?rid=3215444&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F202 Fresh frozen plasma (FFP) is indicated for the management of massive bleedings. Recent audits suggest physician knowledge of FFP is inadequate and half of the FFP transfused in critical care is inappropriate. Trauma is among the largest consumers of FFP. Current trauma resuscitation guidelines recommend FFP to correct coagulopathy only after diagnosed by laboratory tests, often when overt dilutional coagulopathy already exists. The evidence supporting these guidelines is limited and bleeding remains a major cause of trauma-related death. Recent studies demonstrated that coagulopathy occurs early in trauma. A novel early formula-driven haemostatic resuscitation proposes addressing coagulopathy early in massive bleedings with FFP at a near 1:1 ratio with red blood cells. Recent retrospective... Critical Care journals http://www.medworm.com/rss/comments.php?id=3215444 Thu, 28 Jan 2010 00:00:00 +0100 3215444 http://www.medworm.com/index.php?rid=3211195&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F108 Modifying how ICUs are organized and run offer major opportunities to improve outcomes. In this issue, Billington et al. assessed the association of outcomes with intensivists' base speciality. However, very little is known about the relationships between ICU organization and outcomes. In the systems-based paradigm of quality improvement, every aspect of what we do and how we do it is a candidate for study and change. While we need much more rigorous research assessing every aspect of this large question, there are substantial barriers to conducting such studies. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3211195 Wed, 27 Jan 2010 00:00:00 +0100 3211195 http://www.medworm.com/index.php?rid=3211194&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F110 Capnography has been studied for decades as a potential diagnostic tool for suspected pulmonary embolism. Despite technological refinements and its combination with other non-invasive instruments, no evidence to date allows recommending the use of expired CO2 measurement as a rule-out test for PE without additional radiological testing. Further investigations are however still warranted. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3211194 Wed, 27 Jan 2010 00:00:00 +0100 3211194 http://www.medworm.com/index.php?rid=3211193&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR7 Conclusions: The use of a blood conservation device is associated with 1) reduced PRBC requirements and 2) smaller decrease in Hb levels in the ICU. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3211193 Wed, 27 Jan 2010 00:00:00 +0100 3211193 http://www.medworm.com/index.php?rid=3207557&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F105 Continuous renal replacement therapy (CRRT) in pediatric acute kidney dysfunction has evolved in recent decades; however, little objective data exist for complications associated with CRRT. Santiago and colleagues are among the first to documentreport on four complications of acute kidney dysfunction in critically ill children treated at a single center: catheterization-related insertion complications, hypotension, hemorrhage, and electrolyte disturbances. They reported that hypotension at connection (41.3%) and electrolyte disturbance (50.6%) were the leading complications. Although this study is limited by small sample size, definition of acute kidney dysfunction, criteria for initiation of CRRT, clinical significance of complications, and the outcome variables measured, it is an importa... Critical Care journals http://www.medworm.com/rss/comments.php?id=3207557 Tue, 26 Jan 2010 00:00:00 +0100 3207557 http://www.medworm.com/index.php?rid=3196701&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F103 Demand for critical care resources could vastly outstrip supply in an influenza pandemic or other health emergency, which has led expert groups to propose altered standards for triage and resource allocation. A pilot study by Christian et al. applied Ontario, Canada's draft critical care triage protocol to an actual cohort of ICU patients. The findings are troubling. Patients triaged to "expectant" and designated for withdrawal of ICU care and ventilator support in fact had substantial survival rates. Triage officers often disagreed and lacked confidence in their categorization decisions. Rationing paradigms that include categorical "exclusion criteria" and withdrawal of lifesaving resources should be reconsidered in light of these findings, and public input sought on non-clinical aspects.... Critical Care journals http://www.medworm.com/rss/comments.php?id=3196701 Thu, 21 Jan 2010 00:00:00 +0100 3196701 http://www.medworm.com/index.php?rid=3196700&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F104 Throughout the last years, several new diagnostic biomarkers were introduced into clinical routine to identify a systemic inflammatory response syndrome (SIRS) or a septic state and to discriminate between these two entities. According to studies in selected patients, measurement of these biomarkers may be advantageous under certain clinical conditions. On an individual basis however, these sepsis markers usually lack an adequate negative or positive predictive power. Therefore, physicians in charge still have to rely on a combination of personal experience and results from clinical or laboratory tests when deciding on a patients` therapy. For surgical patients, a key problem consists in the time delay which is associated with the diagnosis of serious postoperative infections and which may... Critical Care journals http://www.medworm.com/rss/comments.php?id=3196700 Thu, 21 Jan 2010 00:00:00 +0100 3196700 http://www.medworm.com/index.php?rid=3192593&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR6 Conclusions: Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3192593 Wed, 20 Jan 2010 00:00:00 +0100 3192593 http://www.medworm.com/index.php?rid=3201654&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F401 none (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3201654 Tue, 19 Jan 2010 00:00:00 +0100 3201654 http://www.medworm.com/index.php?rid=3184634&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F101 In this issue of Critical Care, pig experiments are reported, in which, after induction of septic shock, a 'liberal' fluid loading protocol was compared to a more 'restrictive' one, regarding haemodynamics and mortality. It appeared that the former was associated with higher mortalityin spite of improved haemodynamics as compared to the latter. The results of the paper are discussed in view of the scope and mechanisms of these findings. They favor that too much of an otherwise good thing in fluid resuscitation is harmful, even if overhydration and edema formation seem prevented. They also do not exclude a specific toxic effect of the larger volumes of hydroxyethyl starch in the 'liberal' strategy. The precisenature of a toxic effect remains obscure, however, but may involve the kiodneys. (... Critical Care journals http://www.medworm.com/rss/comments.php?id=3184634 Tue, 19 Jan 2010 00:00:00 +0100 3184634 http://www.medworm.com/index.php?rid=3184633&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F102 Arterial pressure optimization in septic shock is a critical, yet poorly understood component of resuscitation. New data suggests that during the routine management of patients with severe sepsis, there is no association between MAP achieved and outcome as long as the MAP is maintained at or above 70 mm Hg. Although these data add important new evidence in our understanding of arterial pressure management, there are still many unanswered questions upon which future investigations should focus. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3184633 Tue, 19 Jan 2010 00:00:00 +0100 3184633 http://www.medworm.com/index.php?rid=3184632&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F401 none (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3184632 Tue, 19 Jan 2010 00:00:00 +0100 3184632 http://www.medworm.com/index.php?rid=3184631&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2F402 not application (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3184631 Tue, 19 Jan 2010 00:00:00 +0100 3184631 http://www.medworm.com/index.php?rid=3184630&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR5 Conclusions: Inclusion of fish oil in parenteral nutrition provided to septic ICU patients increases plasma eicosapentaenoic acid, modifies inflammatory cytokine concentrations and improves gas exchange. These changes are associated with a tendency towards shorter length of hospital stay.Clinical Trials Registration Number: ISRCTN89432944 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3184630 Tue, 19 Jan 2010 00:00:00 +0100 3184630 http://www.medworm.com/index.php?rid=3162876&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR4 Conclusions: Septic plasma induced a direct injury of tubular cells by favouring granulocyte adhesion, by inducing cell apoptosis and by altering cell polarity and function. All these biological effects are related to the presence of circulating inflammatory mediators that can be efficiently removed by resin adsorption with a consequent limitation of tubular cell injury. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3162876 Mon, 11 Jan 2010 00:00:00 +0100 3162876 http://www.medworm.com/index.php?rid=3159236&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR3 Conclusions: Severe burn injury per se could lead to the changes in Tregs activities. Elevated levels of cytokines produced by Tregs and activation markers on Tregs surface might play an important role in the pathogenesis of sepsis and mortality in burned patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3159236 Mon, 11 Jan 2010 00:00:00 +0100 3159236 http://www.medworm.com/index.php?rid=3148311&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F14%2F1%2FR1 Conclusions: Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production as measured in plasma. Our data suggest mechanical ventilation with conventional tidal volumes contributes to development of lung injury in patients without ALI at onset of mechanical ventilation.Trial registration: ISRCTN82533884 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3148311 Thu, 07 Jan 2010 00:00:00 +0100 3148311 http://www.medworm.com/index.php?rid=3132907&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F210 We describe different types of checklists using examples, and explore the benefits they offer to improve care. We suggest methods to create checklists and how we might best apply them using some examples from our own experience, and finally, offer some possible directions for future research. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3132907 Thu, 31 Dec 2009 00:00:00 +0100 3132907 http://www.medworm.com/index.php?rid=3152340&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D Conclusions: Our data demonstrate that HES130/0.4 has similar adverse effects as HES200/0.5. In particular, both types of HES impair coagulation capacity and stimulate rather than attenuate pro-inflammatory platelet function. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3152340 Tue, 22 Dec 2009 00:00:00 +0100 3152340 http://www.medworm.com/index.php?rid=3110401&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR208 Conclusions: Our data demonstrate that HES130/0.4 has similar adverse effects as HES200/0.5. In particular, both types of HES impair coagulation capacity and stimulate rather than attenuate pro-inflammatory platelet function. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3110401 Tue, 22 Dec 2009 00:00:00 +0100 3110401 http://www.medworm.com/index.php?rid=3162877&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D Conclusions: The storage time of the red blood cells used for priming the cardiopulmonary bypass circuit in cardiac operations on newborns and young infants is an independent risk factor for major postoperative morbidity. Pulmonary complications, acute renal failure, and infections are the main complications associated with increased red blood cell storage time. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3162877 Mon, 21 Dec 2009 00:00:00 +0100 3162877 http://www.medworm.com/index.php?rid=3110403&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F235 Primary influenza pneumonia has a high mortality rate during pandemics, not only in immunocompromised individuals and patients with underlying comorbid conditions, but also in young, healthy adults. Clinicians should maintain a high index of suspicion for this diagnosis in patients presenting with influenza-like symptoms that progress quickly (2-5 days) to respiratory distress and extensive pulmonary involvement. The sensitivity of rapid diagnostic techniques in identifying infections with the pandemic 2009 H1N1v influenza strain is currently suboptimal. The most reliable real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) molecular testing is available in limited clinical settings. Despite 6 months of pandemic circulation, most novel H1N1v pandemic strains remain susceptib... Critical Care journals http://www.medworm.com/rss/comments.php?id=3110403 Mon, 21 Dec 2009 00:00:00 +0100 3110403 http://www.medworm.com/index.php?rid=3110402&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR207 Conclusions: The storage time of the red blood cells used for priming the cardiopulmonary bypass circuit in cardiac operations on newborns and young infants is an independent risk factor for major postoperative morbidity. Pulmonary complications, acute renal failure, and infections are the main complications associated with increased red blood cell storage time. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3110402 Mon, 21 Dec 2009 00:00:00 +0100 3110402 http://www.medworm.com/index.php?rid=3099543&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR206 Conclusions: Argon showed a neuroprotective effect in both in vitro models of oxygen-glucose deprivation and traumatic brain injury. Our promising results justify further in vivo animal research. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3099543 Thu, 17 Dec 2009 00:00:00 +0100 3099543 http://www.medworm.com/index.php?rid=3091756&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1016 Great variability exists in data collection and coding of variables in studies on traumatic brain injury. This confounds comparison of results analysis of data across studies. The difficulties in performing a meta-analysis of individual patient data were recently illustrated in the IMPACT project (International Mission on Prognosis and Clinical Trial Design in TBI): merging data from 11 studies involved over 10 person years of work. However, these studies did confirm the great potential for advancing the field by this approach. Although randomized controlled trials remain the prime approach for investigating treatment effects, these can never address the many uncertainties concerning multiple treatment modalities in TBI. Pooling data from different studies may provide the best possible sou... Critical Care journals http://www.medworm.com/rss/comments.php?id=3091756 Wed, 16 Dec 2009 00:00:00 +0100 3091756 http://www.medworm.com/index.php?rid=3091755&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR204 Conclusions: Our review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3091755 Wed, 16 Dec 2009 00:00:00 +0100 3091755 http://www.medworm.com/index.php?rid=3088388&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F430 No description available (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3088388 Tue, 15 Dec 2009 00:00:00 +0100 3088388 http://www.medworm.com/index.php?rid=3084194&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR202 IntroductionVolumetric parameters acquired by transpulmonary thermodilution had been repeatedly proven superior to filling pressures for estimation of cardiac preload. Up to now, the proposed normal ranges were never studied in detail. We investigated the relationship of the global end-diastolic volume (GEDV) acquired by transpulmonary thermodilution with age and gender in awake and spontaneously breathing patients. Methods: Patients requiring brain tumor surgery were equipped prospectively with a transpulmonary thermodilution device. On postoperative day one, thermodilution measurements were performed in 101 patients ready for discharge from the ICU. All subjects were awake, spontaneously breathing, hemodynamically stable and free of catecholamines. Results: Main finding was a dependence ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3084194 Mon, 14 Dec 2009 00:00:00 +0100 3084194 http://www.medworm.com/index.php?rid=3084193&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR203 Conclusion: The coadministration of AT and rhsTM might be effective for the treatment of severe sepsis. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3084193 Mon, 14 Dec 2009 00:00:00 +0100 3084193 http://www.medworm.com/index.php?rid=3081685&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1014 We describe some recent studies focusing on these issues with the hope that they may lead to better treatment for our patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3081685 Fri, 11 Dec 2009 00:00:00 +0100 3081685 http://www.medworm.com/index.php?rid=3081684&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1015 Statin therapy may prevent an excessive inflammatory response after cardiopulmonary bypass for cardiac surgery. In this issued of Critical Care, Morgan et al present data from a well-conducted systematic review and meta-analysis of randomised controlled trials using inflammatory markers as primary outcome measure. They find that pre-operative statin therapy, compared with placebo, may reduce various post-operative markers of systemic inflammation (IL-6, IL-8, C-reactive protein, TNF-a). Their ability to make definitive conclusions is limited however by the sub-optimal methodological quality of the primary studies. Their review suggest that ICU researchers should focus on developing valid surrogate markers and use these to accurately describe the mechanisms and effectiveness of novel therap... Critical Care journals http://www.medworm.com/rss/comments.php?id=3081684 Fri, 11 Dec 2009 00:00:00 +0100 3081684 http://www.medworm.com/index.php?rid=3081683&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR201 Conclusions: While infection with the nvH1N1 induces a typical innate response in both mild and severe patients, severe disease with respiratory involvement is characterized by early secretion of Th17 and Th1 cytokines usually associated with cell mediated immunity but also commonly linked to the pathogenesis of autoimmune/ inflammatory diseases. The exact role of Th1 and Th17 mediators in the evolution of nvH1N1 mild and severe disease merits further investigation as to the detrimental or beneficial role these cytokines play in severe illness. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3081683 Fri, 11 Dec 2009 00:00:00 +0100 3081683 http://www.medworm.com/index.php?rid=3078217&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1013 Cardiogenic shock is a lethal condition. Physicians are searching for hemodynamic markers which could help risk stratification of patients in this picture. Torgersen and coworkers present hourly time integral of cardiac power index and cardiac index drops to predict outcomes in the setting of cardiogenic shock. Continuous monitoring of hemodynamic markers may have a role in prediction of outcomes. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3078217 Thu, 10 Dec 2009 00:00:00 +0100 3078217 http://www.medworm.com/index.php?rid=3074406&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR200 Conclusion: PDDS delivery of aerosolized amikacin achieved very high aminoglycoside concentrations in ELF from radiography-controlled infection-involved zones, while maintaining safe serum amikacin concentrations. The ELF concentrations always exceeded the amikacin minimum inhibitory concentrations for Gram-negative microorganisms usually responsible for these pneumonias. The clinical impact of amikacin delivery with this system remains to be determined. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3074406 Thu, 10 Dec 2009 00:00:00 +0100 3074406 http://www.medworm.com/index.php?rid=3074408&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F429 no abstract, submission changed from a commentary to a topical letter (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3074408 Wed, 09 Dec 2009 00:00:00 +0100 3074408 http://www.medworm.com/index.php?rid=3074407&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR199 Conclusions: Viscoelastic compliance and resistance are highly non-linear with respect to pressure and differ considerably between ARDS and normal lungs. None of these characteristics can be observed for the viscoelastic time constant. From our analysis of viscoelastic properties we cautiously conclude that the energy transfer from the respirator to the lung can be reduced by application of low inspiratory plateau pressures and high respiratory frequencies. This we consider to be potentially lung protective. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3074407 Wed, 09 Dec 2009 00:00:00 +0100 3074407 http://www.medworm.com/index.php?rid=3070217&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR198 Conclusions: Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow. Flow increase was weakly related to the insulin dose, though not to blood glucose concentration.Trial number ISRCTN39026810 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3070217 Wed, 09 Dec 2009 00:00:00 +0100 3070217 http://www.medworm.com/index.php?rid=3066065&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR196 Conclusions: The combination of clinical probability and PetCO2 may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3066065 Tue, 08 Dec 2009 00:00:00 +0100 3066065 http://www.medworm.com/index.php?rid=3066072&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F234 This article aims to review the literature, the clinical and neurobiologic consequences of sleep deprivation, and the potential relationship between sleep deprivation and delirium in ICU patients. Sleep deprivation may prove to be a modifiable risk factor for the development of delirium with important implications for the acute and long term outcome of critically ill patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3066072 Mon, 07 Dec 2009 00:00:00 +0100 3066072 http://www.medworm.com/index.php?rid=3066071&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D No abstract (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3066071 Mon, 07 Dec 2009 00:00:00 +0100 3066071 http://www.medworm.com/index.php?rid=3066070&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1009 Current evidence regarding potentially different host response mechanisms in sepsis according to the type of initiating infection is sporadic. It is possible that alterations in cell populations, variations in effector molecules and the degree of apoptosis differ between sepsis caused by ventilator-associated pneumonia (VAP) and non-VAP sepsis. VAP is one of the most common infections and leading causes of sepsis in the intensive care unit (ICU) and mortality remains high. A better understanding of the unique pathophysiologic features of VAP is needed, in order to develop interventions that target those specific pathways. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3066070 Mon, 07 Dec 2009 00:00:00 +0100 3066070 http://www.medworm.com/index.php?rid=3066069&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1010 Sepsis is a significant public health problem and is one of the leading causes of death in critically ill patient admitted to the intensive care unit (ICU). The cost, both in terms of lives lost and annual health care expenditures from sepsis is staggering. Unfortunately, despite an increasing understanding of the molecular pathobiology of sepsis, the mortality from sepsis has remained more or less stable over the last decade. Moreover, promising therapies in pre-clinical models of sepsis have universally failed to live up to initial expectations in subsequent clinical trials. Multiple studies have demonstrated that apoptosis plays a major role in the pathobiology of sepsis and acute lung injury, making the apoptosis pathway an attractive target for therapy. Herein, the role of apoptosis i... Critical Care journals http://www.medworm.com/rss/comments.php?id=3066069 Mon, 07 Dec 2009 00:00:00 +0100 3066069 http://www.medworm.com/index.php?rid=3066068&cid=s_28800_53_f&fid=28800&url=%24%7Bitem.link%7D Despite extensive research into its pathophysiology, acute lung injury/acute respiratory distress syndrome (ALI/ARDS) remains a devastating syndrome with mortality approaching 40%. Pharmacologic therapies that reduce the severity of lung injury in vivo and in vitro have not yet been translated to effective clinical treatment options, and innovative therapies are needed. Recently, the use of beta2 adrenergic agonists as potential therapy have gain considerable interest due to its ability to increase the resolution of pulmonary edema. However, the results of clinical trials of beta agonist therapy for ALI/ARDS have been conflicting in the terms of benefit. In this issue of Critical Care, Briot et al. present evidence that may help clarify the inconsistent results. The authors demonstrate th... Critical Care journals http://www.medworm.com/rss/comments.php?id=3066068 Mon, 07 Dec 2009 00:00:00 +0100 3066068 http://www.medworm.com/index.php?rid=3066067&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1012 The propofol infusion syndrome is a potentially devastating cardiovascular and metabolic derangement that has been described in both pediatric and adult patients sedated with propofol. Despite a large number of case reports that have appeared in the literature since 1992, the precise clinical features and pathophysiology of this disorder remain uncertain. Historically, the syndrome has been characterized by the occurrence of lactic acidosis, rhabdomyolysis and circulatory collapse after several days of high-dose propofol infusion. The affected patients were typically young and critically ill, and the reported mortality was high. More recently, a number of atypical cases have been reported with favourable outcomes. These occurred after short-term or lower-dose infusions, in non-critically i... Critical Care journals http://www.medworm.com/rss/comments.php?id=3066067 Mon, 07 Dec 2009 00:00:00 +0100 3066067 http://www.medworm.com/index.php?rid=3066066&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR195 IntroductionPassive leg raising (PLR) is a simple reversible maneuver that mimics rapid fluid loading and increases cardiac preload. The effects of this endogenous volume expansion on stroke volume enable the testing of fluid responsiveness with accuracy in spontaneously breathing patients. However, this maneuver requires the determination of stroke volume with a fast-response device, because the hemodynamic changes may be transient. The VigileoTM monitor (VigileoTM; FlotracTM; Edwards Lifesciences, Irvine, CA, USA) analyzes systemic arterial pressure wave and allows continuous stroke volume monitoring. The aims of this study were (i) to compare changes in stroke volume induced by passive leg raising measured with the VigileoTM device and with transthoracic echocardiography and (ii) to com... Critical Care journals http://www.medworm.com/rss/comments.php?id=3066066 Mon, 07 Dec 2009 00:00:00 +0100 3066066 http://www.medworm.com/index.php?rid=3043497&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F233 Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinep... Critical Care journals http://www.medworm.com/rss/comments.php?id=3043497 Tue, 01 Dec 2009 00:00:00 +0100 3043497 http://www.medworm.com/index.php?rid=3043496&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1006 :The multicenter study conducted by Lorente and coworkers published in this issue of Critical Care demonstrates that matrix metalloproteinases-9 and -10 (MMP-9/10) and their inhibitor tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) are promising novel biomarkers to predict severity and outcome of sepsis. In recent years matrix metalloproteinases have emerged as biomarkers in a variety of diseases, such as sepsis, coronary artery disease, cancer, heart failure, chronic lung disease and rheumatoid arthritis. MMPs constitute a family of proteinases that are expressed during developmental, physiological, and pathophysiological processes, for example as a response to infection. Excessive inflammation following infection may cause tissue damage and MMPs are implicated in causing this imm... Critical Care journals http://www.medworm.com/rss/comments.php?id=3043496 Tue, 01 Dec 2009 00:00:00 +0100 3043496 http://www.medworm.com/index.php?rid=3043495&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1007 Water suitable for drinking is unsuited for use in the preparation of haemodialysis fluid and undergoes additional treatment. The primary component of the additional treatment is reverse osmosis, which does not remove low molecular weight contaminants and the water treatment system must contain carbon beds or filters to ensure effective removal of such contaminants.The article by Bek and colleagues highlights an unrecognised issue with respect to chemicals that may be added to the water within hospitals to ensure that the distribution network is free of pathogens (eg, Legionella, pseudomonas, mycobacteria) and underlines the need for personnel responsible for dialysis in a renal or intensive care setting to be aware of any potential effects that disinfection of the hospital water treatment... Critical Care journals http://www.medworm.com/rss/comments.php?id=3043495 Tue, 01 Dec 2009 00:00:00 +0100 3043495 http://www.medworm.com/index.php?rid=3043498&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR192 IntroductionBased on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex (VOR), the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury (sTBI) is possible by means of vestibulo-ocular monitoring (VOM). Methods: VOM is based on video-oculographic (VOG) recording of eye movements during galvanic labyrinth polarization (GaLa). The integrity of VOR is determined from the eye movement response during vestibular GaLa stimulation. VOM is performed within three days after TBI and the oculomotor response (OMR) compared to outcome after six months (Glasgow Outcome Score, (GOS)). Results: Twenty-seven patients underwent VOM within three days after s... Critical Care journals http://www.medworm.com/rss/comments.php?id=3043498 Mon, 30 Nov 2009 00:00:00 +0100 3043498 http://www.medworm.com/index.php?rid=3039022&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR190 IntroductionAngiotensin II (Ang II) is a potential vasopressor treatment for hypotensive hyperdynamic sepsis. However, unlike other vasopressors, its systemic, regional blood flow and renal functional effects in hypotensive hyperdynamic sepsis have not been investigated. Methods: We performed an experimental randomised placebo-controlled animal study.We induced hyperdynamic sepsis by the intravenous administration of live E. coli in conscious ewes after instrumentation with chronic flow probes around the aorta and the renal, mesenteric, coronary and iliac arteries. We allocated animals to either placebo or angiotensin II infusion titrated to maintain baseline blood pressure Results: Hyperdynamic sepsis was associated with increased renal blood flow (from 292+/-61 to 397+/-74 ml/min), oligu... Critical Care journals http://www.medworm.com/rss/comments.php?id=3039022 Mon, 30 Nov 2009 00:00:00 +0100 3039022 http://www.medworm.com/index.php?rid=3039021&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR191 Conclusions: PCC application effectively reduced INRs in anticoagulation reversal, allowing surgical procedures and interventions without major bleeding. In bleeding patients, the improvement in coagulation after PCC administration was judged to be clinically significant. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3039021 Mon, 30 Nov 2009 00:00:00 +0100 3039021 http://www.medworm.com/index.php?rid=3032998&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F427 Not applicable. The present contribution is a letter in response to a manuscript published in critical care. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3032998 Fri, 27 Nov 2009 00:00:00 +0100 3032998 http://www.medworm.com/index.php?rid=3028995&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR188 Conclusions: Our results further confirm the functionality of the IL-10 promoter single nucleotide polymorphisms in relation to IL-10 production. They also suggest that individual difference in IL-10 production in trauma patients might be at least in part related to genetic variations in the IL-10 promoter region. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3028995 Thu, 26 Nov 2009 00:00:00 +0100 3028995 http://www.medworm.com/index.php?rid=3025558&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR187 Conclusions: Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complicationsClinical Trial: anzctr.org.au:ACTRN12606000367549 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3025558 Wed, 25 Nov 2009 00:00:00 +0100 3025558 http://www.medworm.com/index.php?rid=3022129&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F232 Bacterial infection leading to organ failure is the most common cause of death in critically ill patients. Early diagnosis and expeditious treatment is a cornerstone of therapy. Evaluating the systemic host response to infection as a complex system provides novel insights. However, bedside application with clinical value remains wanting. Providing an integrative measure of an altered host response, the patterns and character of heart rate fluctuations measured over intervals-in-time may be analysed with a panel of mathematical techniques that quantify overall fluctuation, spectral composition, scale-free variation, and degree of irregularity or complexity. Using these techniques, heart rate variability (HRV) has been documented to be both altered in the presence of systemic infection, and ... Critical Care journals http://www.medworm.com/rss/comments.php?id=3022129 Tue, 24 Nov 2009 00:00:00 +0100 3022129 http://www.medworm.com/index.php?rid=3022130&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR186 Conclusions: High-volume resuscitation including HES in experimental peritonitis and endotoxemia increased mortality despite better initial hemodynamic stability. This suggests that the strategy of early fluid management influences outcome in sepsis. The high mortality was not associated with reduced mitochondrial complex I- or II-dependent muscle and hepatic respiration. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3022130 Mon, 23 Nov 2009 00:00:00 +0100 3022130 http://www.medworm.com/index.php?rid=3011294&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR185 Conclusions: Our data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS.Trial registration: ISRCTN14110527 (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3011294 Fri, 20 Nov 2009 00:00:00 +0100 3011294 http://www.medworm.com/index.php?rid=3007065&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F425 In Rello et al work 15 out of 32 critical pandemic flu patients did not have any risk factor. A further analysis in this subgroup of patients is needed. Antiviral treatment delay or any other management event differences perhaps were responsible for progressive illness. This data may help management in initial care of pandemic flu patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3007065 Thu, 19 Nov 2009 00:00:00 +0100 3007065 http://www.medworm.com/index.php?rid=3007064&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F426 A report of the demographics, presentation and management of patients with influenza A (H1N1) in a general adult intensive care unit in the United Kingdom. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=3007064 Thu, 19 Nov 2009 00:00:00 +0100 3007064 http://www.medworm.com/index.php?rid=2998571&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR183 IntroductionSevere thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival. Methods: Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of patients that died from anoxic brain injuries, sepsis, or multi-organ failure were calculated by comparing to the total number of deaths. Data was stratified by time (from... Critical Care journals http://www.medworm.com/rss/comments.php?id=2998571 Tue, 17 Nov 2009 00:00:00 +0100 2998571 http://www.medworm.com/index.php?rid=2998572&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1005 Blood stream infections from Candida species are associated with an increased length of stay, increased hospital costs, and higher mortality when compared to bacterial blood stream infections. Delayed or inappropriate therapy in candidemia leads to increased mortality, thus early recognition becomes paramount. With biomarkers showing promise, blood cultures still remain the gold standard but require 24-72 hours for growth. Thus, the reliance on epidemilogic risk factors for the initiation of empiric antifungal therapy provides the best method for early appropriate therapy. Shorr and colleagues have devised a risk score to identify patients with early onset candidemia as defined by positive blood cultures within 2 days of admission, thus allowing for the initiation of early appropriate anti... Critical Care journals http://www.medworm.com/rss/comments.php?id=2998572 Mon, 16 Nov 2009 00:00:00 +0100 2998572 http://www.medworm.com/index.php?rid=2995040&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR182 Conclusions: Our data implicate that MV causes endothelial activation and inflammation in mice without pre-existing pulmonary injury, both in the lung and distal organs. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2995040 Mon, 16 Nov 2009 00:00:00 +0100 2995040 http://www.medworm.com/index.php?rid=2984017&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F424 We claim that sepsis and multiple organ failure represent an adaptive process that aims a survival advantage. Dynamic nature of sepsis comprise all of the key properties of a chaotic system. Chaotic and complex systems actually aim order and integrity, and their behaviours cannot be explained by linear statistical methods. That's why pathophysiology of sepsis and multiple organ failure must be re-modeled within the context of chaos and complexity theories. We also claim that one of the underlying reasons of difficulty in bench to bedside transition of experimental data is the difficulty in applying therapies at the proposed level of action. This decreases the efficacy and safety of treatment. Application of tools provided by nanotechnology can serve to design better therapies that can appl... Critical Care journals http://www.medworm.com/rss/comments.php?id=2984017 Thu, 12 Nov 2009 00:00:00 +0100 2984017 http://www.medworm.com/index.php?rid=2984016&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1004 High mobility group box protein (HMGB1) has been shown to participate in acute inflammatory reactions, including acute lung injury and sepsis. There is also evidence that circulating levels of HMGB1 are increased after severe trauma and are associated with clinically important outcome parameters, including mortality. Recent studies demonstrated that HMGB1 itself has little or no proinflammatory activity, but is able to potentiate inflammatory responses through binding to mediators, such as endotoxin or cytokines. Important questions are to determine the binding partners for HMGB1 in the setting of severe injury and whether inhibition of interactions of HMGB1 and associated molecules with the cell surface can affect outcome after trauma. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2984016 Thu, 12 Nov 2009 00:00:00 +0100 2984016 http://www.medworm.com/index.php?rid=2980052&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F317 The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in critically ill adult patients. In addition, the proposed algorithm is intended to provide a foundation for prospective evaluation and the development of a broad consensus on when to initiate RRT in critically ill patients. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2980052 Wed, 11 Nov 2009 00:00:00 +0100 2980052 http://www.medworm.com/index.php?rid=2980051&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1003 Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer less invasive techniques. For these purposes, the transpulmonary thermodilution technique (TPT) allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. But these metrics remain relatively untested in heart failure. In this issue of Critical Care, Ritter and colleagues compare metrics of TPT to the PAC in patients with acute heart failure (AHF) and severe sepsis. Patients with AHF had a lower cardiac index, a lower left ventricular stroke work index and a higher pulmonary artery occlusion pressure ... Critical Care journals http://www.medworm.com/rss/comments.php?id=2980051 Wed, 11 Nov 2009 00:00:00 +0100 2980051 http://www.medworm.com/index.php?rid=2973348&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1002 Muscle weakness is prevalent in critically ill patients and can have a dramatic effect on short and long term outcomes, yet there are currently no interventions with proven efficacy in preventing or treating this complication. In a new randomized trial, researchers found that serial electrical muscle stimulation significantly mitigated ultrasound-defined muscle atrophy, and the treatment was not linked to adverse effects. Although preliminary, these results, together with other recent studies, indicate a paradigm shift to a more proactive approach in managing neuromuscular complications in the ICU. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2973348 Mon, 09 Nov 2009 00:00:00 +0100 2973348 http://www.medworm.com/index.php?rid=2966152&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F199 Intra-abdominal hypertension (IAH) is increasingly recognized to be both prevalent and clinically important in medical and surgical ICUs. Intra-abdominal pressure (IAP) can impact organ function throughout the body, and it can also complicate standard measurements used in ICU care. The article by Krebs et al. reports the effect of IAP on respiratory function, gas exchange and hemodynamic function. Their results show a relatively small effect of modestly elevated IAP on these variables in their patient population. However, their work raises several questions for clinicians and researchers regarding the pathophysiology and management of IAP. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2966152 Fri, 06 Nov 2009 00:00:00 +0100 2966152 http://www.medworm.com/index.php?rid=2966151&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2F1001 Septic patients may require anaesthesia for surgery or to facilitate endotracheal intubation for respiratory failure. These patients frequently start with a deranged haemodynamic state including vasodilation with hypotension, and cardiomyopathy, making induction of anaesthesia a potentially hazardous task. Anaesthetic agents are well known to decrease contractility and cause vasodilation, in part from direct effect of the drugs, and in part due to the "state of anaesthesia" which causes reduced sympathetic tone. Before induction, the physician should understand the haemodynamic state (especially using echocardiography), restore cardiovascular reserve with inotropes and vasopressors, and induce anaesthesia with the smallest dose of the safest drug. In this issue of Critical Care, Zausig and... Critical Care journals http://www.medworm.com/rss/comments.php?id=2966151 Fri, 06 Nov 2009 00:00:00 +0100 2966151 http://www.medworm.com/index.php?rid=2966150&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR177 Conclusions: In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported. These results should be interpreted with caution due to the methodological weaknesses in the historical control studies. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2966150 Fri, 06 Nov 2009 00:00:00 +0100 2966150 http://www.medworm.com/index.php?rid=2957938&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR174 Conclusions: The results of this study demonstrate for the first time that HMGB1 is released into the bloodstream early after severe trauma in humans. The release of HMGB1 requires severe injury and tissue hypoperfusion, and is associated with posttraumatic coagulation abnormalities, activation of complement and severe systemic inflammatory response. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2957938 Wed, 04 Nov 2009 00:00:00 +0100 2957938 http://www.medworm.com/index.php?rid=2953636&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR173 Conclusions: Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2953636 Tue, 03 Nov 2009 00:00:00 +0100 2953636 http://www.medworm.com/index.php?rid=2953637&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F6%2FR172 Conclusions: Decrease of CD4-lymphocytes and immunoparalysis of monocytes are characteristic alterations of sepsis arising in the field of VAP. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2953637 Mon, 02 Nov 2009 00:00:00 +0100 2953637 http://www.medworm.com/index.php?rid=2942508&cid=s_28800_53_f&fid=28800&url=http%3A%2F%2Fccforum.com%2Fcontent%2F13%2F5%2F423 No Abstract. (Source: Critical Care) Critical Care journals http://www.medworm.com/rss/comments.php?id=2942508 Fri, 30 Oct 2009 00:00:00 +0100 2942508