MedWorm: Intensive Care

Single Course of Antenatal Steroids Did Not Alter Cortisol in Preterm Infants to 18 months

Acta Paediatrica — Thu, 09 Feb 2012 05:42:45 +0100

Conclusions: No effect of a single course of dexamethasone on resting salivary cortisol, an indicator of hypothalamic‐pituitary‐adrenal axis function, was found in infancy up to 18 months corrected age in infants born very preterm.© 2012 The Author(s)/Acta Pædiatrica © 2012 Foundation Acta Pædiatrica (Source: Acta Paediatrica)

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Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

Critical Care — Thu, 09 Feb 2012 05:00:00 +0100

Conclusions: Despite a paucity of sufficiently powered prospectively randomized trials, we were able to establish an evidence-based appraisal of this field and develop a set of consensus recommendations to standardize care and direct further research for patients with cirrhosis and renal dysfunction. (Source: Critical Care)

Lung recruitment in ARDS - we are still confused, but on a higher PEEP level

Critical Care — Thu, 09 Feb 2012 05:00:00 +0100

Recruitment maneuvers and the application of high levels of positive end-expiratory pressure combined with lung protective mechanical ventilation strategies have been proposed to improve pulmonary function in patients with severe acute respiratory distress syndrome. However, the optimal way to achieve and maintain alveolar recruitment is still under debate. (Source: Critical Care)

Acute pulmonary oedema in chronic dialysis patients admitted into an intensive care unit

Nephrology Dialysis Transplantation — Thu, 09 Feb 2012 05:00:00 +0100

Conclusions. APO fuelled in part by chest infection, excessive interdialytic weight gain and inappropriate dry weight are important causes of hospitalization in CD patients. Mortality is high among those referred from other services usually in critical conditions. (Source: Nephrology Dialysis Transplantation)

Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy

Nephrology Dialysis Transplantation — Thu, 09 Feb 2012 05:00:00 +0100

Conclusion. Our study demonstrates that RDW could be an additive predictor for all-cause mortality in AKI patients on CRRT treatment in the ICU. (Source: Nephrology Dialysis Transplantation)

Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients

Nephrology Dialysis Transplantation — Thu, 09 Feb 2012 05:00:00 +0100

Conclusion. The inflammatory response induced by sepsis has no impact on the levels of cystatin C in plasma during the first week in the ICU. (Source: Nephrology Dialysis Transplantation)

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Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

Advances in Pharmacological Sciences — Wed, 08 Feb 2012 18:37:00 +0100

We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention req...

A handoff is not a telegram: understanding of the patient is co-constructed

Critical Care — Wed, 08 Feb 2012 05:00:00 +0100

Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient. (Source: Critical Care)

Sepsis and septic shock: the potential for gene arrays

Critical Care — Wed, 08 Feb 2012 05:00:00 +0100

Over the past decade several investigators have applied microarray technology and related bioinformatic approaches to clinical sepsis and septic shock, thus allowing for an assessment of how, or if, this branch of genomic medicine has meaningfully impacted the field of sepsis research. The ability to simultaneously and efficiently measure the steady-state mRNA abundance of thousands of transcripts from a given tissue source (that is, 'transcriptomics') has provided an unprecedented opportunity to gain a broader, genome-level 'picture' of complex and heterogeneous clinical syndromes such as sepsis. A trancriptomic approach to sepsis and septic shock is technically challenging on multiple levels, but nonetheless modest, tangible advances are being realized. These include a genome-level under...

Humidifiers during noninvasive mechanical ventilation

Critical Care — Wed, 08 Feb 2012 05:00:00 +0100

Inadequate gas conditioning during non-invasive ventilation (NIV) can impair the anatomy and function of nasal mucosa. The resulting symptoms may have a negative effect on patients' adherence to ventilatory treatment, especially for chronic use. Several parameters, mostly technical aspects of NIV, contribute to inefficient gas conditioning. Factors affecting airway humidity during NIV include inspiratory flow, inspiratory oxygen fraction, leaks, type of ventilator, interface used to deliver NIV, temperature and pressure of inhaled gas, and type of humidifier. The correct application of a humidification system may avoid the effects of NIV-induced drying of the airway. This brief review analyses the consequences of airway dryness in patients receiving NIV and the technical tools necessary to...

Inflammasome and caspase-1 inhibition caused by Bcl-2 and Bcl-XL may influence cytokine responses of lipopolysaccharide stimulated peripheral blood mononuclear cells from septic patients

Critical Care — Wed, 08 Feb 2012 05:00:00 +0100

no abstract available. (Source: Critical Care)

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Correction: Screening and control of methicillin-resistant Staphylococcus aureus in 186 intensive care units: different situations and individual solutions

BioMed Central — Wed, 08 Feb 2012 05:00:00 +0100

Following publication of our article [1], Dr Christine Geffers has been removed as co-author. (Source: BioMed Central)

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

Critical Care — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: In a low endemic setting for MRSA, RDT safely reduced the number of unnecessary isolation days on ICUs by 44%, at the costs of E121.76 to E136.04 per isolation day avoided. (Source: Critical Care)

Family nurture intervention (FNI): methods and treatment protocol of a randomized controlled trial in the NICU

BMC Pediatrics - Latest articles — Tue, 07 Feb 2012 05:00:00 +0100

This study is a randomized controlled trial (RCT) with blinded assessment comparing Standard Care (SC) with a novel Family Nurture Intervention (FNI). FNI targets preterm infants born 26-34 weeks postmenstrual age (PMA) and their mothers in the NICU. The intervention incorporates elements of mother-infant interventions with known efficacy and organizes them under a new theoretical context referred to collectively as calming activities. This intervention is facilitated by specially trained Nurture Specialists in three ways: 1) In the isolette through calming interactions between mother and infant via odor exchange, firm sustained touch and vocal soothing, and eye contact; 2) Outside the isolette during holding and feeding via the Calming Cycle; and 3) through family sessions designed to eng...

Clarification of Conflict of Interest Disclosures in: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes [Correction]

JAMA — Tue, 07 Feb 2012 05:00:00 +0100

(Source: JAMA)

Incorrect Work Group Name in: Enteral Omega-3 Fatty Acid, {gamma}-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury [Correction]

JAMA — Tue, 07 Feb 2012 05:00:00 +0100

(Source: JAMA)

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Laparoscopic versus Open Colectomy for Colon Cancer in an Older Population: A Cohort Study

World Journal of Surgical Oncology — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: In this older population, laparoscopic colectomy practice patterns were associated with factors which likely correlate with tertiary referral centers. Although short-term and long-term survival are comparable, laparoscopic colectomy offers shorter hospitalizations and less intensive care. (Source: World Journal of Surgical Oncology)

The sensitivity of neutrophil CD64 expression as a biomarker of bacterial infection is low in critically ill patients

Intensive Care Medicine — Mon, 06 Feb 2012 19:37:30 +0100

Conclusions The CD64 index is specific for bacterial infection among ICU patients. As a result of its weak sensitivity, the CD64 index may not be practically recommended, but it may be useful in combination with a more sensitive biological marker. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-012-2483-6Authors Antoine Gros, Division of Infectious Diseases and Critical Care, Pontchaillou Hospital, 35033 Rennes Cedex, FranceMikael Roussel, Hematology and Immunology Laboratory, Pontchaillou Hospital, 35033 Rennes Cedex, FranceElise Sauvadet, Division of Infectious Diseases and Critical Care, Pontchaillou Hospital, 35033 Rennes Cedex, FranceArnaud Gacouin, Division of Infectious Diseases and Critical Care, Pontchaillou Hospital, 35033 Rennes Ce...

Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage

Neurocritical Care — Mon, 06 Feb 2012 19:36:06 +0100

Conclusions Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s12028-012-9679-zAuthors Ashley R. Catalano, Department of Neurosurgery, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1136, New York, NY 10029, USAH. R. Winn, Department of Neurosurgery, Lennox Hill Hospital, 100 East 77th Street, New York, NY 10075, USAErrol Gordon, Neuroscience Intensive Care Unit, Departments of Neurosurgery and Neurology, Mount Sinai School of Medicine, New York, NY, USAJennifer A. Frontera, ...

Science Weekly podcast: Transplants and the future of intensive care

Guardian Unlimited Science — Mon, 06 Feb 2012 14:05:00 +0100

This week, we're focusing on some pivotal stories from the history of science and medicine. First up are human-to-human transplants and intensive care medicine. These are among the greatest successes of post-war medicine, but they also raise some of the most profound ethical questions. Ahead of a discussion at the Royal Institution in London, Kevin Fong, an anaesthetist and physiology lecturer at University College London, and medical historian Richard Barnett came into the studio to discuss how these important medical interventions started and, crucially, where they are heading. The debates will be held at the Royal Institution on 28 February. "From iron lungs to intensive care", "Hearts to hearts" will be on 15 February.The Observer's science editor, Robin McKie, was on hand to delve int...

Drotrecogin alfa (activated) ... a sad final fizzle to a rollercoaster party

Critical Care — Mon, 06 Feb 2012 05:00:00 +0100

Following the failure of PROWESS-SHOCK to demonstrate efficacy, Eli Lilly and Company withdrew drotrecogin alfa (activated) from the worldwide market. Drotrecogin was initially approved after the original trial, PROWESS, was stopped early for overwhelming efficacy. These events prompt consideration of both the initial approval decision and the later decision to withdraw. It is regrettable that the initial decision was made largely on a single trial that was stopped early. However, the decision to approve was within the bounds of normal regulatory practice and was made by many approval bodies around the world. Furthermore, the overall withdrawal rate of approved drugs remains very low. The decision to withdraw was a voluntary decision by Eli Lilly and Company and likely reflected key ...

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The risk factors for the prognosis of acute kidney injury under AKIN definition: a retrospective, multicenter study in critically ill patients

Nephrology — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: For critically ill patient, the ICU mortality of AKI was correlated with various independent risk factors, especially AKI II, AKI III, severe acute pancreatitis and multiple organ failed systems.© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology (Source: Nephrology)

Poor Outcomes at Discharge Among Extremely Premature Infants: A National Population-Based Study [Article]

Archives of Pediatrics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions The combined outcomes of deaths or severe morbidities in the neonatal period of infants born at 24 to 26 weeks' gestation could be simply estimated at birth. The provision of an appropriate and up-to-date estimate of poor neonatal outcomes for specific infants may be useful in counseling families on treatment options for these infants. (Source: Archives of Pediatrics)

Fifty Years of Work on the Artificial Placenta: Milestones in the History of Extracorporeal Support of the Premature Newborn

Artificial Organs — Mon, 06 Feb 2012 05:00:00 +0100

AbstractThe concept of an artificial placenta has been pursued in experimental research since the early 1960s. The principle has yet to be successfully implemented in neonatal care despite the constant evolution in extracorporeal life support technology and advancements in neonatal intensive care in general. For more than three decades, the physical dimensions of the required equipment necessitated pump‐driven circuits; however, recent advances in oxygenator technology have allowed exploration of the simpler and physiologically preferable concept of pumpless arteriovenous oxygenation. We expect that further miniaturization of the extracorporeal circuit will allow the implementation of the concept into clinical application as an assist device. To this end, NeonatOx (Fig. 1), a custom‐...

Optimization of oxygen delivery during high-risk surgery: keep the concept but refining goals for inotrope infusion?

Critical Care — Mon, 06 Feb 2012 05:00:00 +0100

We read with great interest the recent study by Lobo and colleagues stating that fluid restriction during optimization of oxygen delivery (DO2) using dobutamine improves patient outcome after major surgery. Previous studies have shown that haemodynamic optimization using either an individualized goal-directed fluid substitution or inotrope to maximize DO2 reduces postoperative morbidity and hospital length of stay. Although the study brings important new insights, we believe however that some limits should be pointed. (Source: Critical Care)

Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial [Caring for the Critically Ill Patient]

JAMA — Sun, 05 Feb 2012 05:00:00 +0100

Conclusion In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.Trial Registration clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948 (Source: JAMA)

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Nutrition for Critically Ill Patients: How Much Is Enough? [Editorial]

JAMA — Sun, 05 Feb 2012 05:00:00 +0100

(Source: JAMA)

Hinchingbrooke: a private solution for a hospital in intensive care

Telegraph Health — Sat, 04 Feb 2012 19:00:16 +0100

There is nothing wrong, in principle, with handing control of an NHS hospital to a private company, argues Alasdair Palmer. (Source: Telegraph Health)

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients

BioMed Central — Sat, 04 Feb 2012 05:00:00 +0100

Power injectable peripherally inserted central catheters can be used successfully in most intensive care unit patients with few contraindications and low rates of complications, similar to central venous catheters (CVC). (Source: BioMed Central)

Talin, Vinculin and Nestin Expression in Orofacial Muscles of Dystrophin Deficient mdx Mice

Archivum Immunologiae et Therapiae Experimentalis — Fri, 03 Feb 2012 17:10:48 +0100

Abstract The activity of cytoskeletal proteins like talin, vinculin and nestin increases in muscle that regenerates. Little is known about their role or at least their expression in the process of regeneration in masticatory muscles of mdx mice, a model of Duchenne muscular dystrophy. To determine a potential role of cytoskeletal proteins in the regeneration process of mdx masticatory muscles, we examined the expression of talin 1, talin 2, vinculin and nestin in 100-day-old control and mdx mice using quantitative RT-PCR, Western blot analyses and histochemistry. The protein expression of talin 1, talin 2, nestin and vinculin in mdx muscles remained unchanged as compared with normal mice. However, in mdx masseter it was found a relative increase of nestin compared to contr...

Continuous Near-Infrared Regional Cerebral Perfusion Monitoring Shows Promise in Stroke Patients

Medgadget Anesthesiology — Fri, 03 Feb 2012 16:47:02 +0100

Researchers at Mayo Clinic in Florida have shown that cerebral optically-based near infra-red spectroscopic oximetry applied to patients who have suffered a stroke can help monitor regional cerebral perfusion in real time, and thus “may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner.” The study looked at the device called Fore-Sight from Casmed of Branford, CT, that measures blood oxygen, similar to a finger clip pulse oximeter. The Mayo study results have been published in Journal of Neurosurgery this month.Regional cerebral blood flow monitoring devices such as Fore-Sight are already in wide deployment in cardiac surgery, where they are thought to prevent brain ischemia in patients undergoing major s...

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Making the move: from bedside to camera-side

ICMCC: The International Council on Medical and Care Compunetics — Fri, 03 Feb 2012 15:35:28 +0100

Source: Goran SF. Critical Care Nurse, 32(1) Content: The tele-intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Evaluation of exercise capacity using wave intensity in chronic heart failure with normal ejection fraction

Heart and Vessels — Fri, 03 Feb 2012 07:22:08 +0100

In conclusion, W2 is considered to be clinically more useful than conventional TTE indices for evaluating exercise capacity in patients with chronic HFNEF. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00380-011-0224-3Authors Yoichi Takaya, Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 JapanManabu Taniguchi, Division of Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, JapanMotoaki Sugawara, Department of Medical Engineering, Himeji Dokkyo University, Himeji, JapanSaori Nobusada, Division of Central Clinical Laboratory, Okayama University Hospital, Okayama, JapanKengo Kusano, Department of Cardiovascular Medicine, Okayama University Graduate School of...

Sepsis-induced acute kidney injury—is there a lack of energy?

Intensive Care Medicine — Fri, 03 Feb 2012 07:21:33 +0100

Content Type Journal ArticleCategory EditorialPages 1-3DOI 10.1007/s00134-012-2489-0Authors Robert Frithiof, Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Renal bioenergetics during early gram-negative mammalian sepsis and angiotensin II infusion

Intensive Care Medicine — Fri, 03 Feb 2012 07:21:32 +0100

Conclusions During early hypotensive experimental Gram-negative sepsis, there was no evidence of renal bioenergetic failure despite decreased RBF. In this setting, the addition of a powerful renal vasoconstrictor does not lead to deterioration in renal bioenergetics. Content Type Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-012-2487-2Authors Clive N. May, Howard Florey Institute, Florey Neurosciences Institutes, University of Melbourne, Parkville, VIC, AustraliaKen Ishikawa, Howard Florey Institute, Florey Neurosciences Institutes, University of Melbourne, Parkville, VIC, AustraliaLi Wan, Howard Florey Institute, Florey Neurosciences Institutes, University of Melbourne, Parkville, VIC, AustraliaJohn Williams, Howard Florey Institute, Florey Neurosc...

Brain Tissue Oxygenation and Cerebral Perfusion Pressure Thresholds of Ischemia in a Standardized Pig Brain Death Model

Neurocritical Care — Fri, 03 Feb 2012 07:21:15 +0100

Conclusions A severe increase of ICP leading to CPP below 30 mmHg and BtipO2 below 10 mmHg is associated with an increase of the L/P ratio, thus seems to be critical thresholds for cerebral ischemia under these conditions. Content Type Journal ArticleCategory Translational ResearchPages 1-8DOI 10.1007/s12028-012-9675-3Authors Karlis Purins, Department of Neuroscience, Section of Neurosurgery, Uppsala University, 751 85 Uppsala, SwedenPer Enblad, Department of Neuroscience, Section of Neurosurgery, Uppsala University, 751 85 Uppsala, SwedenLars Wiklund, Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, SwedenAnders Lewén, Department of Neuroscience, Section of Neurosurgery, Uppsala University, 751 85 Up...

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Enhancing Braden pressure ulcer risk assessment in acutely ill adult veterans

Wound Repair and Regeneration — Fri, 03 Feb 2012 05:00:00 +0100

This study sought to determine if a parsimonious pressure ulcer (PU) predictive model could be identified specific to acute care to enhance the current PU risk assessment tool (Braden Scale) utilized within veteran facilities. Factors investigated include: diagnosis of gangrene, anemia, diabetes, malnutrition, osteomyelitis, pneumonia/pneumonitis, septicemia, candidiasis, bacterial skin infection, device/implant/graft complications, urinary tract infection, paralysis, senility, respiratory failure, acute renal failure, cerebrovascular accident, or congestive heart failure during hospitalization; patient's age, race, smoking status, history of previous PU, surgery, hours in surgery; length of hospitalization, and intensive care unit days. Retrospective chart review and logistic regression a...

A prospective randomized open-label crossover trial of regional citrate anticoagulation vs. anticoagulation free liver dialysis by the Molecular Adsorbents Recirculating System

Critical Care — Fri, 03 Feb 2012 05:00:00 +0100

IntroductionThe Molecular Adsorbent Recycling System (MARS) is used to treat patients with liver failure. Observational data suggest that citrate anticoagulation during MARS is feasible. Comparative studies on the optimal anticoagulation regimen during MARS are lacking. The aim of the current study was to evaluate two heparin-free anticoagulation regimens. Methods: We performed a prospective randomized open-label crossover study of regional citrate anticoagulation against no anticoagulation. Ten patients (age 55 +/- 11 years) with liver failure undergoing MARS treatment were included. The primary endpoint was completion of MARS sessions. Secondary endpoints included treatment efficacy and safety. Longevity of MARS treatment was plotted as a Kaplan-Meier estimate. Fisher's exact test was us...

St. Elizabeth denied NICU unit

bizjournals.com Health Care:Pharmaceuticals headlines — Thu, 02 Feb 2012 21:28:49 +0100

St. Elizabeth Healthcare has been denied Kentucky approval to open an advanced neonatal intensive care unit. The hospital system applied in 2009 for the Level III NICU designation. But it failed to convince the Kentucky Cabinet for Health and Family Services the Kentucky needs the 12-bed service. A spokeswoman for the organization said St. Elizabeth is likely to appeal the decision. St. Elizabeth hoped to lure back the 990 Northern Kentucky women who leave the state to have their babies at Cincinnati Children’s Hospital Medical Center or elsewhere... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery

Journal of Anesthesia — Thu, 02 Feb 2012 18:14:05 +0100

Conclusions Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00540-012-1326-5Authors Fernando José Abelha, Anesthesiology and Perioperative Care Unit, Surgical Department, Faculty of Medicine, University of Porto, Porto, PortugalVera Fernandes, Department of Anesthesiology, Centro Hospitalar de São João, Porto, PortugalMiguela Botelho, Department of Anesthesiology, Centro Hospitalar de São João, Porto, PortugalPatricia Santos, Department of Anesthesiology, Centro Hospitalar de São João, Porto,...

Contrast-induced acute kidney injury: what is the prevalence of prevention protocols?

Intensive Care Medicine — Thu, 02 Feb 2012 18:13:11 +0100

Content Type Journal ArticleCategory CorrespondencePages 1-1DOI 10.1007/s00134-012-2479-2Authors Jamie M. Strachan, Intensive Care Unit, Royal Berkshire Hospital, Reading, RG1 5AN UKMichael P. J. DeVile, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, OX3 9DU UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction

Intensive Care Medicine — Thu, 02 Feb 2012 18:13:11 +0100

Conclusion Copeptin in association with HsTnT is a fast and reliable tool to rule out AMI, with a sensitivity and NPV of 1.00 in our sample. Interventional studies are warranted to confirm these findings. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-012-2481-8Authors Yonathan Freund, Service d’Accueil des Urgences, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris (APHP), Université Pierre et Marie Curie-Paris 6 (UPMC), 47-83 Boulevard de l’Hôpital, 75651 Paris cedex 13, FranceCamille Chenevier-Gobeaux, Departement de Biochimie, Hôpital Cochin–Hôtel Dieu, APHP, 27 rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, FranceYann-Erick Claessens, Service d’Accueil des Urgences, Hôpital Cochin–Hôtel Dieu, AP...

Acute Treatment Options for Spinal Cord Injury

Current Treatment Options in Neurology — Thu, 02 Feb 2012 18:12:19 +0100

Opinion statement Most treatment options for acute traumatic spinal cord injury (SCI) are directed at minimizing progression of the initial injury and preventing secondary injury. Failure to adhere to certain guiding principles can be detrimental to the long-term neurologic and functional outcome of these patients. Therapy for the hyperacute phase of traumatic SCI focuses on stabilizing vital signs and follows the Advanced Trauma Life Support (ATLS) algorithm for ensuring stability of airway, breathing and circulation, and disability (neurologic evaluation)—with spinal stabilization—and exposure. Spinal stabilization, with cervical collars and long backboards, is used to prevent movement of a potentially unstable spinal column injury to prevent further injury to the sp...

Sepsis Immunopathology: Perspectives of Monitoring and Modulation of the Immune Disturbances

Archivum Immunologiae et Therapiae Experimentalis — Thu, 02 Feb 2012 18:11:05 +0100

Abstract Septic syndromes are the main cause of death in the intensive care units and although the mortality rates is slowly decreasing, the occurrence of the disease has been increasing. The pathogenesis of sepsis includes countless disturbances of the host immune system starting with a harmful, infection-triggered exaggerated inflammatory cascade, followed by the development of an immunoparalysis state. The latter contributes to the failure in pathogen eradication and leads to secondary infections, which are often the cause of fatal complications. In this review, we consider different novel therapeutic strategies for restoration of immune function. The use of glucocorticoids, intravenous immunoglobulins, heparin, recombinant human activated protein C, granulocyte macroph...

Anti-Xa Levels 4 h After Subcutaneous Administration of 5,700 IU Nadroparin Strongly Correlate with Lean Body Weight in Morbidly Obese Patients

Obesity Surgery — Thu, 02 Feb 2012 17:58:24 +0100

Abstract Background Morbidly obese patients (BMI > 40 kg/m2) are at increased risk for venous thromboembolism, especially after surgery. Despite limited evidence, morbidly obese patients are often administered a double dose of nadroparin for thromboprophylaxis compared to non-obese patients. The aim of this study was to evaluate the influence of different body size descriptors on anti-Xa levels after a double dose of nadroparin (5,700 IU) in morbidly obese patients. Methods In 27 morbidly obese patients with a mean total body weight of 148 kg (range 107–260 kg), anti-Xa levels were determined peri-operatively until 24 h after administration of a subcutaneous dose of 5,700 IU of nadroparin. Results &nbs...

Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

Intensive Care Medicine — Thu, 02 Feb 2012 06:55:38 +0100

Conclusions Free fatty acids respond to intensive glycemic control and, because of their high toxicity, can be a therapeutic target in patients with sepsis. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2458-zAuthors Sylas B. Cappi, Laboratório da Disciplina de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3187, São Paulo, SP 01246-913, BrazilDanilo T. Noritomi, Laboratório da Disciplina de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3187, São Paulo, SP 01246-913, BrazilIrineu T. Velasco, Laboratório da Disciplina de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala...

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The neonate presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Pediatrics International — Thu, 02 Feb 2012 05:00:00 +0100

Conclusions: Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first three days of life. Two thirds of them had culture proven or clinical sepsis. Temperature symptoms were rarely observed in EOS negative newborns (8%) but despite low sensitivity highly specific for bacterial infection in preterm and term newborns.© 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society (Source: Pediatrics International)

Renal Replacement Therapy in Cardiology Wards: Changing Trends in a Transitional Country

Therapeutic Apheresis and Dialysis — Thu, 02 Feb 2012 05:00:00 +0100

AbstractThe leading causes of death in patients with chronic kidney disease (CKD) are cardiovascular diseases, regardless of the stage of disease or method of renal replacement therapy. On the other hand, CKD is a major risk factor for cardiovascular complications after acute myocardial infarction, as well as for adverse outcome in patients with chronic heart failure. In the present study we prospectively followed‐up nephrological interventions in cardiology wards in order to determine changes in indications, treatment possibilities and outcome of patients. All patients treated at cardiology ward of the Clinical Hospital Centre Zagreb and requiring renal replacement therapy from January 2003 to December 2009 were included in the investigation. Cardiology hospital unit (intensive care or ...

Treatment of Neurocritical Care Emergencies in Pregnancy

Current Treatment Options in Neurology — Wed, 01 Feb 2012 17:14:15 +0100

Opinion statement Neurologic emergencies are a major cause of morbidity and mortality in pregnant women. In part because the patient population is young, the nihilistic approach that often accompanies neurologically devastating disorders in other contexts is largely absent. A number of studies have demonstrated improved patient outcomes in the setting of aggressive care delivered by neurointensivists in a specialty-specific environment. It stands to reason that young, pregnant women who suffer from neurologically devastating disorders and who have a wide range of prognosis may also benefit from such specialized care. Close collaboration between obstetricians and neurointensivists is critical in this context. A number of unique considerations in diagnosis and management pre...

Validation of the Better Care® system to detect ineffective efforts during expiration in mechanically ventilated patients: a pilot study

Intensive Care Medicine — Wed, 01 Feb 2012 17:14:14 +0100

Conclusions In this pilot, Better Care® classified breaths as IEE in close agreement with experts and the EAdi signal. Content Type Journal ArticleCategory OriginalPages 1-9DOI 10.1007/s00134-012-2493-4Authors Lluis Blanch, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainBernat Sales, CIBER Enfermedades Respiratorias, ISCiii, Madrid, SpainJaume Montanya, Fundació Parc Tauli, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, SpainUmberto Lucangelo, Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, ItalyOscar Garcia-Esquirol, Critical Care Cente...

Ineffective efforts during mechanical ventilation: the brain wants, the machine declines

Intensive Care Medicine — Wed, 01 Feb 2012 17:14:13 +0100

Content Type Journal ArticleCategory EditorialPages 1-3DOI 10.1007/s00134-012-2497-0Authors Dimitris Georgopoulos, Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Review of Inhaled Nitric Oxide in the Pediatric Cardiac Surgery Setting

Pediatric Cardiology — Wed, 01 Feb 2012 17:13:49 +0100

Abstract Surgical intervention for congenital heart disease (CHD) can be complicated by pulmonary hypertension (PH), which increases morbidity, mortality, and medical burden. Consequently, postoperative management of PH is an important clinical consideration to improve outcomes. Inhaled nitric oxide (iNO) is a widely accepted standard of care for PH and has been studied in the context of cardiac surgery for CHD. However, large randomized, double-blind, placebo-controlled, multicenter clinical trials in pediatric patients are limited. This review will provide an overview of the clinical studies in this setting and will discuss general treatment considerations to facilitate a better understanding of the clinical use of iNO for PH after pediatric cardiac surgery. Content ...

MCQs

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

(pp 56–58) Which of the following delay gastric emptying? (Source: Anaesthesia and intensive care medicine)

Drugs and the liver

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: The liver is a major organ with multiple functions. Many drugs are metabolized by the liver during phase 1 and 2 reactions which include complex processes involving cytochrome P450. Additionally, drugs can also modify how the liver functions and cause dysfunction or even failure of the organ both by a direct effect on the liver or by alteration in liver blood flow. It is important to recognize the signs and symptoms of liver failure in patients and identify possible causes including drug interactions. Furthermore, once a patient has been recognized to be suffering with liver dysfunction or failure drug choice and dosing regime will need to be rationalized.Paracetamol overdose can have severe and life-threatening consequences for patients due to its effect on liver function. It is...

Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motility

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Gastric disorders have clinical implications in both anaesthesia and critical care medicine. Aspiration of acidic gastric contents in the perioperative setting is linked to pneumonitis and later development of pneumonia. Pharmacological strategies to minimize this risk include histamine-2 receptor antagonists, sucralfate, proton pump inhibitors and sodium citrate. Use of gastric acid-suppressing therapy is widespread in critical care. The aim is to reduce the incidence of stress-related mucosal bleeding. Intestinal failure is common in critical illness. Medications that decrease gastric motility and contribute to ileus, include opioid analgesics, catecholamines and α2-adrenoceptor antagonists. Current pharmacological strategies for increasing gastric motility include the use of ...

Central nervous system stimulants: basic pharmacology and relevance to anaesthesia and critical care

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Sympathomimetic agents are commonly encountered in anaesthetic and critical care settings. Some only act on autonomic nervous system reflexes, whilst others affect higher mental function – thus these agents are used frequently in the clinical setting, as well as being drugs of abuse (e.g. the amphetamines). Competition for various metabolic and transport processes can lead to dangerous drug interactions, with sympathetic nervous system overactivity being the major consequence leading to morbidity. They are an important group of drugs and a detailed understanding of their pharmacology is vital to the safe practice of anaesthesia and critical care medicine.Respiratory stimulants also have their place in modern medical treatment. Doxapram and the methylxanthines are used clinicall...

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Digestion and absorption

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Carbohydrates, mostly as starch, are digested by salivary and pancreatic amylases to di-, tri- and oligosaccharides, then to monosaccharides by saccharidases on the wall of the small intestine, following which they are absorbed. Proteins are absorbed as amino acids and small peptides that are broken down further, in the cell, to amino acids. Monosaccharides and amino acids pass to the liver via the portal vein. Fats are digested and absorbed as free fatty acids and glycerides and are then mostly reconstituted to triglycerides in the mucosal cells of the small intestine. They combine with phospholipids and a protein to form chylomicrons, which pass via the lymphatics and the thoracic duct into the general circulation. Fatty acids are released in the tissues and are then either re-...

Gut motility and its control

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: The gastrointestinal tract is composed of smooth muscle arranged in two layers: longitudinal and circular. Although its activity is influenced by the autonomic nervous system, it is mainly under local reflex control mediated by an enteric nervous system and local hormones. The motility of the gastrointestinal tract has several different well-defined patterns. Its function is to move the gastrointestinal contents through the various phases of homogenization (mixing), digestion, absorption and elimination. (Source: Anaesthesia and intensive care medicine)

The mouth, stomach and intestines

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Food is divided into digestible portions in the mouth and swallowed – a complex reflex process involving several cranial nerves. The stomach homogenizes food, begins digestion and regulates the rate at which food enters the duodenum. Pancreatic juices containing powerful digesting enzymes are added and digestion is completed in the small intestine. The large bowel dehydrates the gastrointestinal contents. (Source: Anaesthesia and intensive care medicine)

Metabolic functions of the liver

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: The liver is one of the most important organs in the body and serves a variety of important functions including metabolic, vascular, immunological, secretory and excretory functions. It plays a key role in the carbohydrate, protein and fat metabolism in the human body. In this article, we outline a brief overview of the metabolic functions. (Source: Anaesthesia and intensive care medicine)

Functional anatomy and blood supply of the liver

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: The liver is the second-largest organ in the human body. Traditionally, the anatomy of the liver has been described on the basis of its external appearance/gross anatomy. However, with the increase in surgical procedures, for example resection and transplant, the need for a more functional description of the liver based on its vascular and biliary architecture evolved. Different models of functional anatomy of the liver have been described in the literature in the past, but Couinaud’s model of functional anatomy of the liver is the most popular. The liver has dual vascular supply, with most of its supply coming from the portal vein and the remainder through the hepatic artery. In this article, we outline the functional anatomy of the liver along with its blood supply. (Source:...

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Anaesthesia and minimally invasive surgery

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

This article will focus on the pathophysiological changes caused by CO2 pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications. (Source: Anaesthesia and intensive care medicine)

Laboratory tests in hepatic failure

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Laboratory tests of liver function are among most commonly ordered blood tests. However, interpretation of parameters should be based not only on measuring the metabolic and synthetic function of the liver, but also parameters which reflect liver injury. Clinical and laboratory assessment of liver function help to identify causes of liver failure, monitor clinical deterioration and prognosis, and determine treatment options including liver transplantation. (Source: Anaesthesia and intensive care medicine)

Clinical aspects of hepatic disease

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: Liver disease has a high prevalence. Patients with advanced liver disease have poor outcome after surgery. Prognostic scoring systems help to identify those at high risk. Chronic liver disease is associated with typical extra-hepatic manifestations, resulting from failure to clear endogenous vasodilators, splanchnic vasodilation, high cardiac output and decreased central blood volume. Complications include hepatorenal syndrome, hepatopulmonary syndrome and porto-pulmonary hypertension. In fulminant liver failure, cerebral oedema is a prominent feature. Without liver transplantation, prognosis is dismal. Appreciation of the multi-system sequelae of liver disease is a prerequisite to appropriate management. (Source: Anaesthesia and intensive care medicine)

Anaesthesia for gastrointestinal surgery

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

This article will discuss how to recognize these problems and try to minimize their impact on recovery. A growing body of evidence shows that adoption of a package of care known collectively as enhanced recovery significantly reduces postoperative morbidity and reduces length of hospital stay. For anaesthetists the changes involve analgesic regimens and perioperative fluid and nutrition management. This evidence has been brought together in the national Enhanced Recovery After Surgery Programme and has been introduced to many hospitals for elective bowel surgery patients. The principles of the programme will be discussed. Aspects of it can be applied to many other surgical groups. (Source: Anaesthesia and intensive care medicine)

Editorial Board

Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Anaesthesia and intensive care medicine)

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Anaesthesia and intensive care medicine — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Anaesthesia and intensive care medicine)

A model program for perinatal palliative services.

Advances in Neonatal Care — Wed, 01 Feb 2012 05:00:00 +0100

This article describes a Perinatal Comfort Care program in which (a) care is provided at the time of diagnoses/antenatally and includes home visits by members of an interdisciplinary hospice team; (b) care is collaborative, community-based, and family-centered, and takes place in labor and delivery and on the mother baby unit; and (c) follow-up to the family continues for 1 year after the death. Neonatal nurses can become involved either by initiating efforts to form a perinatal comfort care program or by joining an existing team. PMID: 22301541 [PubMed - in process] (Source: Advances in Neonatal Care)

Implementing practice guidelines and education to improve care of infants with neonatal abstinence syndrome.

Advances in Neonatal Care — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSION: : Evidence-based clinical practice guidelines and education around NAS and the FNAST equip caregivers with the necessary tools to consistently and accurately assess an infant with NAS when using the FNAST. PMID: 22301543 [PubMed - in process] (Source: Advances in Neonatal Care)

Enteral Feeding Practices in the NICU: Results from a 2009 Neonatal Enteral Feeding Survey.

Advances in Neonatal Care — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: : Research is needed to provide a foundation on which to develop effective enteral feeding protocols that are appropriate for the diversity of infants cared for in the NICU. Such research findings will culminate in the development and implementation of enteral feeding protocols in the NICU, which will result in improved nutrition, growth, and development outcomes for premature infants. PMID: 22301544 [PubMed - in process] (Source: Advances in Neonatal Care)

The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit: NANN Position Statement #3052.

Advances in Neonatal Care — Wed, 01 Feb 2012 05:00:00 +0100

Authors: PMID: 22307278 [PubMed - in process] (Source: Advances in Neonatal Care)

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Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients.

Neurosurgical Focus — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions The authors demonstrated a linear correlation for frontal NIRS cerebral oxygenation measurements compared with regional CBF on CT perfusion imaging. Thus, frontal NIRS cerebral oxygenation measurement may serve as a useful, noninvasive, bedside intensive care unit monitoring tool to assess brain oxygenation in a direct manner. PMID: 22296679 [PubMed - in process] (Source: Neurosurgical Focus)

Editorial Board

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Journal of Critical Care)

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Journal of Critical Care)

Intensive care admissions and outcome at the University of Calabar Teaching Hospital, Nigeria

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: An intensive care unit (ICU) is for critically ill patients who are likely to benefit from the expertise care provided. The outcome is dependent on the available human and material resources. The University of Calabar Teaching Hospital is a 410-bed hospital. It has a 3-bed general ICU consisting of 2 adult and 1 pediatric beds. A retrospective analysis of all ICU admissions as well as the mortality rate during a 12-month period that spans April 2009 and March 2010 was done. The data were collected from the ICU admissions and nurses' report books. The data extracted were the patients ages, stratified to pediatric (0-18 years) and adult (>18 years); the source of admission, primary diagnosis, the duration of admission, and the patients who were ventilated were also noted. The outco...

2011 Reviewers

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

(Source: Journal of Critical Care)

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2011—year in review

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

The year 2011 marked the first year the Journal of Critical Care published on a bimonthly schedule. This, coupled with an increased page allocation and accelerated submission rate, has created a robust and increasingly visible publication that depends upon its volunteer reviewers to succeed. Therefore, it is not only appropriate and fitting but also a pleasure and responsibility to thank the Journal's nine hundred fifty-eight completed reviews (out of 2024 invitations) 2011 reviewers for their expert commentaries, unstinting commitment to excellence, and selfless dedication to the concept that peer review is one of the highest forms of academic commitment and a bastion of journalistic integrity. This year has seen a number of challenges to the reputation of the process, but despite several...

Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI)

Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: In this in vivo ovine model, both recipient and blood product factors contributed to the development of TRALI. Sick (LPS infused) sheep rather than healthy (saline infused) sheep predominantly developed TRALI when transfused with supernatant from stored but not fresh PRBC. "Stored PRBC" induced a more severe injury than "stored PLT" and had a different storage lesion profile, suggesting that these outcomes may be associated with storage lesion factors unique to each blood product type. Therefore, the transfusion of fresh rather than stored PRBC may minimise the risk of TRALI. (Source: Critical Care)

Pulmonary complications after major head and neck surgery: A retrospective cohort study

The Laryngoscope — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions:Patients undergoing major head and neck surgery are at high risk of PPCs. Advanced age and hypertension significantly correlated with PPCs. PPCs correlate with prolonged ICU and hospital stays, and increased mortality. Further research is needed to define risk factors, useful investigations, and effective optimization strategies to mitigate PPCs. (Source: The Laryngoscope)

How to solve the problem of spontaneous bacterial clearance when testing new antibiotic treatment: results on experimental pneumonia due to a derepressed cephalosporinase‐producing Enterobacter cloacae

Fundamental and Clinical Pharmacology — Wed, 01 Feb 2012 05:00:00 +0100

AbstractBecause the magnitude of spontaneous bacterial clearance can be similar or even higher than treatment effect, depending upon experimental model and bacterial strain used, this work investigated the value of rendering rats immunosuppressed to facilitate bacterial implantation and reduce spontaneous bacterial clearance. In a first step, rats received a single intravenous cyclophosphamide dose 4 days before infection. Three different doses were tested: 10, 20, and 40 mg/kg. After modeling with NONMEM V, the cyclophosphamide dose required to maintain white blood cell count <1.0 × 103/μL from day 4 to day 5 was 30 mg/kg. In a second step, influence of immunosuppression on lung bacterial titers was characterized. Rats were given one of the three intravenous cyclophosphamid...

Epidemiological features and risk factor analysis of children with acute lung injury.

World Journal of Pediatrics : WJP — Wed, 01 Feb 2012 05:00:00 +0100

CONCLUSIONS: ARDS has a high mortality rate in PICU, especially in those with extra-pulmonary diseases. In addition to aggressive medical management of comorbidity, lung protection and avoidance of discharge against medical advice will decrease the mortality. PMID: 22282381 [PubMed - in process] (Source: World Journal of Pediatrics : WJP)

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Outcomes of living‐donor liver transplantation in patients with preoperative type‐1 hepatorenal syndrome and acute hepatic decompensation

Liver Transplantation — Tue, 31 Jan 2012 18:57:13 +0100

In conclusion, HRS patients, compared with non‐HRS patients, had worse postoperative renal function and overall survival. However, their five‐year overall survival rate was still nearly 80%, which is satisfactory. Therefore, living‐donor liver transplantation can be considered for patients who have acute hepatic decompensation with or without HRS. © 2012 American Association for the Study of Liver Diseases (Source: Liver Transplantation)

Selective decontamination in European intensive care patients

Intensive Care Medicine — Tue, 31 Jan 2012 16:48:00 +0100

Content Type Journal ArticleCategory EditorialPages 1-6DOI 10.1007/s00134-012-2488-1Authors Evelien A. N. Oostdijk, Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA Utrecht, The NetherlandsBastiaan H. J. Wittekamp, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The NetherlandsChristian Brun-Buisson, INSERM U955, Université Paris Est-Créteil, Créteil, FranceMarc J. M. Bonten, Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA Utrecht, The Netherlands Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Segmentation and quantification of intra-ventricular/cerebral hemorrhage in CT scans by modified distance regularized level set evolution technique

International Journal of Computer Assisted Radiology and Surgery — Tue, 31 Jan 2012 16:47:02 +0100

Conclusions The MDRLSE improved the accuracy and speed for segmentation and calculation of the hemorrhage volume compared to the original DRLSE method. The method generates quantitative information, which is useful for specific decision making and reduces the time needed for the clinicians to localize and segment the hemorrhagic regions. Content Type Journal ArticleCategory Original ArticlePages 1-14DOI 10.1007/s11548-012-0670-0Authors K. N. Bhanu Prakash, Biomedical Imaging Lab, SBIC, Biopolis, Agency for Science, Technology and Research, #07-01, Matrix, 30, Biopolis Road, Singapore, 138671 SingaporeShi Zhou, Biomedical Imaging Lab, SBIC, Biopolis, Agency for Science, Technology and Research, #07-01, Matrix, 30, Biopolis Road, Singapore, 138671 SingaporeTim C. Morg...

Opportunities And Challenges Of Palliative Care In The ICU Discussed In Expert Roundtable

Health News from Medical News Today — Tue, 31 Jan 2012 11:00:00 +0100

If you think palliative care and the ICU don't go together, think again. The importance and potential benefits of palliative care to ease suffering and improve quality of life for patients being treated in hospital intensive care units (ICUs) has received increasing recognition but is not without significant challenges, as discussed in a Roundtable discussion in Journal of Palliative Medicine, a peer-reviewed journal published by Mary Ann Liebert, Inc... (Source: Health News from Medical News Today)

Early peak temperature and mortality in critically ill patients with or without infection

Intensive Care Medicine — Tue, 31 Jan 2012 07:11:09 +0100

Conclusions Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically ill patients with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-012-2478-3Authors Paul Jeffrey Young, Medical Research Institute of New Zealand, Intensive Care Research, Wellington Regional Hospital, Intensive Care Unit, Wellington, New ZealandManoj Saxena, St George Clinical School, University of New South Wales, Sydney, NSW, AustraliaRichard Beasley, Medical Research Institute of New Zealand, Wellington, New ZealandRinaldo Bellomo, Austin Hospital, Intensive Care Unit, Melbourne, VIC, Austr...

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Infections in Pediatric Intensive Care Units (PICU)

Indian Journal of Pediatrics — Tue, 31 Jan 2012 07:09:36 +0100

Content Type Journal ArticleCategory CommentaryPages 1-3DOI 10.1007/s12098-012-0696-xAuthors Chand Wattal, Department of Clinical Microbiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, IndiaJ. K. Oberoi, Department of Clinical Microbiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India Journal Indian Journal of PediatricsOnline ISSN 0973-7693Print ISSN 0019-5456 (Source: Indian Journal of Pediatrics)

Pediatric Intensive Care Unit: An Essential Service to Improve Survival of Childhood Cancer in Developing World

Indian Journal of Pediatrics — Tue, 31 Jan 2012 07:09:35 +0100

Content Type Journal ArticleCategory Scientific Letter to the EditorPages 1-2DOI 10.1007/s12098-012-0686-zAuthors Mohammed Ramzan, Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, 110060 IndiaSatya P. Yadav, Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, 110060 IndiaDhiren Gupta, Pediatric Intensive Care Unit, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, IndiaSanjeev Arora, Pediatric Intensive Care Unit, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, IndiaAnupam Sachdeva, Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Institute o...

Severe gastro-oesophageal reflux necessitating fundoplication after percutaneous endoscopic and open gastrostomy in children

Langenbeck's Archives of Surgery — Tue, 31 Jan 2012 07:04:16 +0100

Conclusion The results of this study indicated a higher incidence for severe GER leading to fundoplication in children with OG, while no difference with complications and clinical outcome between the two techniques, OG and PEG, were observed. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00423-012-0909-9Authors Hannu Lintula, Department of Paediatric Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, FinlandHannu Kokki, Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, FinlandPetri Juvonen, Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, F...

Unusual case of right atrial reinfarction.

Atherosclerosis — Tue, 31 Jan 2012 05:19:26 +0100

Authors: Radojevic N, Savic S, Aleksic V, Cukic D Abstract It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was fille...

Pragmatic fluid optimization in high risk surgery patients: when pragmatism dilutes the benefits

Critical Care — Tue, 31 Jan 2012 05:00:00 +0100

There is increasing evidence that hemodynamic optimization by fluid loading, particularly when performed in the early phase of surgery, is beneficial in high-risk surgery patients: it leads to a reduction in postoperative complications and even to improved long-term outcome. However, it is also true that goal- directed strategies of fluid optimization focusing on cardiac output optimization have not been applied in the clinical routine of many institutions. Reasons are manifold: disbelief in the level of evidence and on the accuracy and practicability of the required monitoring systems, and economics. The FOCCUS trial examined perioperative fluid optimization with a very basic approach: a standardized volume load with 25 ml/kg crystalloids over 6 hours immediately prior to scheduled surger...

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Effects of hypercapnia and NO synthase inhibition in sustained hypoxic pulmonary vasoconstriction

Respiratory Research — Tue, 31 Jan 2012 05:00:00 +0100

Conclusion: Hypercapnia with and without acidosis increased HPV during conditions of sustained hypoxia. The increase of sustained HPV and endothelial permeability in hypoxic hypercapnia without acidosis is iNOS dependent. (Source: Respiratory Research)

ECMO Centers and Mortality From Influenza A(H1N1)--Reply [Letters]

JAMA — Tue, 31 Jan 2012 05:00:00 +0100

(Source: JAMA)

ECMO Centers and Mortality From Influenza A(H1N1) [Letters]

JAMA — Tue, 31 Jan 2012 05:00:00 +0100

(Source: JAMA)

Impact of preoperative Angiotensin-converting enzyme inhibitor use on clinical outcomes after cardiac surgery.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:20:13 +0100

CONCLUSIONS: We found no association between preoperative ACEi therapy and adverse in-hospital outcomes or long-term survival after CABG. Preoperative ACEi therapy appears to be safe in patients undergoing CABG. PMID: 22269723 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Combination of two urinary biomarkers predicts acute kidney injury after adult cardiac surgery.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:20:03 +0100

CONCLUSIONS: When urinary L-FABP and NAG are combined, they can detect AKI adequately, even in a heterogeneous population of adult post-cardiac surgery AKI. Combining 2 markers with different sensitivity and specificity presents a reasonable strategy to improve the diagnostic performance of biomarkers. PMID: 22269724 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring

Journal of Clinical Monitoring and Computing — Mon, 30 Jan 2012 16:07:40 +0100

In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients. Content Type Journal ArticlePages 1-6DOI 10.1007/s10877-012-9337-1Authors Heath E. Latham, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USAScott T. Rawson, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USATimothy T. Dwyer, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3007, Kansas City, KS 66160, USAChirag C. Patel, Division of Pulmonary and Critical Care Medicine, The University of Kansas Medical Center, 390...

Opportunities and challenges of palliative care in the ICU discussed in expert roundtable

EurekAlert! - Social and Behavioral Science — Mon, 30 Jan 2012 05:00:00 +0100

(Mary Ann Liebert, Inc./Genetic Engineering News) If you think palliative care and the ICU don't go together, think again. The importance and potential benefits of palliative care to ease suffering and improve quality of life for patients being treated in hospital intensive care units has received increasing recognition but is not without significant challenges, as discussed in a Roundtable discussion in Journal of Palliative Medicine, a peer-reviewed journal published by Mary Ann Liebert, Inc. (Source: EurekAlert! - Social and Behavioral Science)

Low doses of esmolol and phenylephrine act as diuretics during intravenous anesthesia

Critical Care — Mon, 30 Jan 2012 05:00:00 +0100

IntroductionThe renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but experiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the adrenergic balance is modified. Methods: 60 females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to control group and received only the conventional anesthetic drugs and 20 ml/kg of lactated Ringer's over 30 mins. The others were also given an infusion of 50 ug/kg/min of esmolol (beta1-receptor blocker) or 0.01 ug/kg/min of phenylephrine (alpha1-adrenergic agonist) over 3 hours. The distribution and elimination of infused fluid was studied by volume kinetic analysis based on urinary excretion and blood hemoglobin level. Results: Both drug...

Effect of acute hyperventilation on the venous-arterial PCO2 difference

Critical Care — Mon, 30 Jan 2012 05:00:00 +0100

I read with great interest the article by Morel et al. [1], suggesting that acute changes in the arterial partial pressure of carbon dioxide (PaCO2) can affect the venous-arterial difference in carbon dioxide tension ([increment]CO2). Ten ventilated and hemodynamically stable patients were included after elective cardiac surgery. Hypocapnia was induced by increasing of respiratory rate. The authors found that a decrease of PaCO2 was associated with a significant increase in [increment]CO2. This was explained by the fact that acute hypocapnia resulted in systemic vasoconstriction, thus decreasing the elimination of the total CO2 produced by the peripheral tissues, and therefore increased the gap. However, as all patients were monitored with a pulmonary artery catheter (PAC), the authors sho...

Economic Evaluation of Protocols Evaluated in the ICUEconomic Evaluation of Protocols Evaluated in the ICU

Medscape Today Headlines — Mon, 30 Jan 2012 04:00:00 +0100

Intensive care medicine is expensive. Can these patient-driven protocols save institutions money? The Annals of Pharmacotherapy (Source: Medscape Today Headlines)

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Silent Pain in the Neck

AORN Journal — Mon, 30 Jan 2012 03:56:37 +0100

A 60-year-old man underwent an elective anterior cervical discectomy for persistent right arm weakness caused by cervical stenosis. Later that night, he developed tightness and swelling on the right side of his neck. The surgical unit nurse notified the covering physician, who asked about stridor or other respiratory symptoms. When told that they were absent, he recommended continued close observation. During the next few hours, the patient's symptoms persisted, and he experienced mild dysphagia. The nurse contacted the inhouse intensivist, who evaluated the patient and again found no evidence of respiratory distress or stridor. A few hours later, the patient stood up from bed to use the urinal, began coughing, turned cyanotic, and fell to the floor unconscious. Cardiopulmonary resuscitati...

The deceased organ donor with an “open abdomen”: proceed with caution

Transplant Infectious Disease — Sun, 29 Jan 2012 05:00:00 +0100

AbstractIn solid organ transplantation, the disparity between donor supply and patients awaiting transplant continues to increase. The organ shortage has led to relaxation of historic contraindications to organ donation. A large percentage of deceased organ donors have been subjected to traumatic injuries, which can often result in intervention that leads to abdominal packing and intensive care unit resuscitation. The donor with this “open abdomen” (OA) presents a situation in which the risk of organ utilization is difficult to quantify. There exists a concern for the potential of a higher risk for both bacterial and fungal infections, including multidrug‐resistant (MDR) pathogens because of the prevalence of antibiotic use and critical illness in this population. No recommendations ...

Unusual case of right atrial reinfarction

Journal of Forensic and Legal Medicine — Sat, 28 Jan 2012 08:18:45 +0100

Abstract: It is well known that atrial infarctions are rare comparing to the ventricular. They cannot easily be verified on ECG and the standard autopsy technique does not include a detailed review of the atrial wall, so the atrial infarction often remains undiagnosed. A 63-year-old male was treated and died in an intensive care unit due to decompensated liver insufficiency and cardiac disease following long-lasting alcohol abuse. At autopsy, the extreme cardiomegaly was found, severe atherosclerosis of the anterior descending branch of left coronary artery. The posterior wall of the right atrium was thickened (cca 9 mm) in diameter of cca 3 × 3 cm, and this area was yellowish in the luminal part, while the central part was filled with dark red blood. A detailed dissection of the coron...

Circadian rhythm disruption in severe sepsis: the effect of ambient light on urinary 6-sulfatoxymelatonin secretion

Intensive Care Medicine — Sat, 28 Jan 2012 06:42:36 +0100

Conclusions Circadian rhythm was disrupted in patients with severe sepsis, as reflected by disordered diurnal variation of urinary 6-SMT excretion. Light levels were low, exhibited limited diurnal variation, and did not entrain circadian rhythms in these patients. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-012-2494-3Authors Avelino C. Verceles, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USALeann Silhan, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USAMichael Terrin, Division of Pulmonary and Cr...

Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

Indian Journal of Palliative Care — Sat, 28 Jan 2012 05:00:00 +0100

Surjya Prasad Upadhyay, Piyush Narayan Mallick, Waleed Mohamed Elmatite, Manish Jagia, Salah TaqiIndian Journal of Palliative Care 2011 17(3):251-254Many patients are admitted to the intensive care unit (ICU) for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 ) agonist, has been used ...

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The Use of Human Milk in the Neonatal Intensive Care Unit: Practices in Belgium and Luxembourg

Breastfeeding Medicine — Sat, 28 Jan 2012 04:04:15 +0100

Breastfeeding Medicine , Vol. 0, No. 0. (Source: Breastfeeding Medicine)

Left atrial appendage occlusion in valvular atrial fibrillation following MitraClip implantation

Clinical Research in Cardiology — Fri, 27 Jan 2012 17:53:44 +0100

Content Type Journal ArticleCategory Letter to the EditorsPages 1-4DOI 10.1007/s00392-012-0416-6Authors Alexander Jabs, 2nd Department of Medicine, Cardiology/Angiology/Intensive Care, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, GermanyUlrich Hink, 2nd Department of Medicine, Cardiology/Angiology/Intensive Care, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, GermanyAscan Warnholtz, 2nd Department of Medicine, Cardiology/Angiology/Intensive Care, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, GermanyRalph Stephan von Bardeleben, 2nd Department of Medicine, Cardiology/Angiology/Intensive Care, University Medical Center of the...

S-ketamine concentrations are greatly increased by grapefruit juice

European Journal of Clinical Pharmacology — Fri, 27 Jan 2012 17:52:01 +0100

Conclusions Grapefruit juice significantly increased the plasma concentrations of oral ketamine in healthy volunteers. Dose reductions of ketamine should be considered when using oral ketamine concomitantly with grapefruit juice. Content Type Journal ArticleCategory Pharmacokinetics and DispositionPages 1-8DOI 10.1007/s00228-012-1214-9Authors Marko A. Peltoniemi, Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, P.O. Box 52, Kiinamyllynkatu 4-8, FI-20520 Turku, FinlandTeijo I. Saari, Department of Anesthesiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, GermanyNora M. Hagelberg, Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, P.O. Box 52, Kiinam...

Acute intermittent porphyria, an important and rare differential diagnosis of acute abdomen: case report and literature review

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

This article presents a literature review and reports on a case of porphyric crisis initially diagnosed as acute abdomen and treated with an inconclusive exploratory laparotomy During the postoperative period, the patient progressed with tetraparesis, tetraplegia and respiratory distress, suggesting Guillain-Barre syndrome, which was precluded after cerebrospinal fluid analysis revealed no albumin-cytological dissociation. The patient was admitted to the intensive care unit due to her neurological disorders, which required ventilation support. After admission, she progressed with choluria and seizures. A porphyric crisis was suspected and confirmed upon a 24 hour urine porphyrins test. Supportive therapy was initiated, but due to unavailability in our hospital, heme derivatives were not gi...

Meningitis and infective endocarditis caused by Rhodotorula mucilaginosa in an immunocompetent patient

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

Os autores relatam o caso de um homem imunocompetente admitido com comprometimento agudo do sistema nervoso, crise hipertensiva e insuficiência renal, vindo a receber diagnóstico de meningite e endocardite infecciosa por Rhodotorula mucilaginosa. Até onde sabemos, esta é a primeira descrição de infecção simultânea das meninges e do endotélio causada por Rhodotorula em um paciente sem comprometimento imunológico.The authors report the case of an immunocompetent man who presented with acute impairment of the neurological system, hypertensive crisis and renal failure. The patient was eventually diagnosed with Rhodotorula mucilaginosa meningitis and infective endocarditis. To the best of our knowledge, this is the first description of simultaneous infection of the meninges and endot...

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Novel biomarkers in severe community-acquired pneumonia

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

A pneumonia adquirida na comunidade é a doença infecciosa que mais comumente exige internação em unidades de terapia intensiva e o diagnóstico precoce e preciso da pneumonia adquirida na comunidade ainda é um desafio. Os biomarcadores desempenham um importante papel auxiliando no julgamento clínico no Serviço de Emergência e são adjuvantes na avaliação da resposta terapêutica. Novos biomarcadores como cortisol, proadrenomedulina e endotelina-1 demonstraram estar associados a gravidade da doença e a evolução em curto prazo. Este artigo de revisão irá se basear no uso clínico de novos biomarcadores, na sua capacidade de predizer gravidade e de monitorar a resposta ao tratamento empregado.Community-acquired pneumonia (CAP) is the most common infectious disease requiring adm...

Nutritional therapy and neonatal sepsis

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

This article reviews the current understanding of enteral and parenteral nutrition therapy in preterm infants, with an emphasis on very low birth weight babies. The protective effects of nutrition therapy against neonatal sepsis and necrotizing enterocolitis are discussed. Different methods of feeding preterm infants are evaluated. Special attention is given to the problems of very low birth weight babies and the protective effects of nutrition to counteract complications, especially infection. The preferential use of breast milk for enteral nutrition, the management of protein and energy offers, the use of early and minimal enteral nutrition, the early introduction of parenteral nutrition (within the first 24 hours of life) and the use of immunonutrients that are appropriately supported b...

Clostridium tetani infections in newborn infants: a tetanus neonatorum review

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

A despeito de ser uma doença imunoprevenível, o tétano permanece ceifando vidas em diferentes regiões do planeta. Se para a doença de origem acidental a ocorrência de novos casos reflete a insuficiente imunização da população, no caso do tétano neonatorum o problema tem dupla natureza: a precária cobertura vacinal dos adultos e as dificuldades de acesso ao pré-natal de qualidade, situação agudizada pela extrema gravidade da moléstia nesta faixa etária, cuja letalidade pode chegar a 80%. Deste modo, ainda que seja importante o reconhecimento precoce do tétano no recém-nato para seu pronto e adequado tratamento, o aspecto de maior relevância é, indubitavelmente, a implementação de adequadas medidas de profilaxia e controle. Com base nestas premissas, propõe-se, neste ...

Adrenal insufficiency in children with sepsis

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: This study determined the frequency of adrenal insufficiency in children with sepsis and its relationship to increased mortality within the first 28 post-admission days. No statistically significant association was found between adrenal insufficiency and mechanical ventilation time or the use of vasoactive drugs. (Source: Revista Brasileira de Terapia Intensiva)

Evaluation of postoperative pain experience in intensive care unit patients

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: The nursing team was apparently more concerned with the presence of pain than with its quality, severity or possible painful stimuli. Pain scales were not used, which suggests the need for continued education of the nursing professionals on the manner of approaching their patients and assessing their patients' pain. (Source: Revista Brasileira de Terapia Intensiva)

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Professional profile of pediatric intensivists in Rio de Janeiro, southeastern Brazil

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

OBJETIVO: Este estudo tem como objetivo descrever o perfil sócio-demográfico e aspectos da qualificação profissional dos médicos intensivistas pediátricos do Estado do Rio de Janeiro (RJ), sudeste do Brasil. MÉTODOS: Estudo observacional, transversal e descritivo, realizado em unidades de tratamento intensivo neonatal, pediátrica e mista do RJ. Utilizou-se questionário semi-estruturado, anônimo e individual, respondido de modo voluntário pelos médicos das unidades que participaram do estudo. Foram considerados como perdas os questionários não devolvidos em 30 dias e excluídos os que tiveram menos de 75% das questões respondidas. As diferenças de formação entre intensivistas neonatais e pediátricos foram comparadas através do teste do Qui-quadrado, com nível de signifi...

The neuroprotective role of therapeutic hypothermia after cardiac arrest

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

In this study, therapeutic hypothermia was applied to all post-cardiorespiratory arrest patients and demonstrated good neurological outcome in surviving patients. (Source: Revista Brasileira de Terapia Intensiva)

End of life in intensive care: family members' acceptance of orthotanasia

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

OBJETIVOS: O objetivo deste estudo foi avaliar o posicionamento dos familiares sobre a ortotanásia, ao considerar controle dos sintomas, preferência do paciente e influência da satisfação da comunicação do tratamento informado pela equipe médica. MÉTODOS: Foi realizado um estudo descritivo na unidade de terapia intensiva geral adulto do Hospital do Servidor Público Estadual durante o período de um ano. Utilizou-se um questionário estruturado, baseado no Quality of Dying and Death (QODD 22) e entrevista informal prévia. RESULTADOS: Foram avaliados 60 familiares, com 51,7 ± 12,1 anos, sendo 81,7 % do sexo feminino. Os pacientes estavam internados em média por 31 ± 26,9 dias, sendo que 17,0% dos dias na unidade de terapia intensiva. A maioria apresentava doença neurológica. ...

Clinical-pathological discrepancies in critically ill patients with difficult premortem diagnoses

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: We found significant discrepancies between clinical and pathological findings, reinforcing the value of postmortem examination. (Source: Revista Brasileira de Terapia Intensiva)

Lethality and osteomuscular and cardiovascular complications in tetanus

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: The present study demonstrates the failure of primary medical care in vaccination and post-traumatic tetanus prophylaxis. Despite improvements in intensive care support, cardiovascular complications are still frequent in these patients. Individuals exhibiting high APACHE II scores and severe clinical forms of tetanus should be monitored closely due to a risk of death and cardiovascular complications. (Source: Revista Brasileira de Terapia Intensiva)

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Association between organ dysfunction and cytokine concentrations during the early phases of septic shock

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction. (Source: Revista Brasileira de Terapia Intensiva)

Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

A morte encefálica induz várias alterações fisiopatológicas que podem causar lesões em rins, pulmões, coração e fígado. Portanto, a atuação do intensivista durante a manutenção do potencial doador falecido exige cuidados específicos com estes órgãos visando sua maior viabilidade para transplantes. O manejo hemodinâmico cuidadoso, os cuidados ventilatórios e de higiene brônquica minimizam a perda de rins e pulmões para o transplante. A avaliação da condição morfológica e funcional do coração auxilia na avaliação do potencial transplantável deste órgão. Por fim, a avaliação da função hepática, assim como o controle metabólico e a realização de sorologias virais são fundamentais para a orientação das equipes transplantadoras na seleção do órgão ...

Guidelines for the management of accidental tetanus in adult patients

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

O tétano acidental, a despeito de ser uma doença prevenível por imunização, ainda é frequente nos países subdesenvolvidos e em desenvolvimento. Sua letalidade ainda é elevada e os estudos sobre a melhor forma de tratamento são escassos. Tendo em vista esta escassez e a importância clínica dessa doença, um grupo de especialistas reunidos pela Associação de Medicina Intensiva Brasileira (AMIB), desenvolveu recomendações baseadas na melhor evidencia disponível para o manejo do tétano no paciente necessitando cuidados intensivos. As recomendações incluem aspectos relativos à admissão do paciente tetânico na unidade de terapia intensiva, tratamento com imunoglobulinas, tratamento antibiótico, manejo da analgossedação e bloqueio neuromuscular, manejo da disautonomia e e...

Adequate nutrition can improve the outcome of premature infants

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

(Source: Revista Brasileira de Terapia Intensiva)

End-of-life care in Brazilian ICUs is not just a legal issue: adequate training and knowledge are essential to improve care

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

(Source: Revista Brasileira de Terapia Intensiva)

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Trismus, opisthotonus and risus sardonicus: who remembers this disease?

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

(Source: Revista Brasileira de Terapia Intensiva)

Influence of acute preload changes on mitral annulus velocity measured by tissue doppler echocardiography in critically ill patients

Journal of Clinical Ultrasound — Fri, 27 Jan 2012 08:28:07 +0100

Conclusions.This study confirms the preload dependence and limited clinical usefulness of most Doppler variables, such as e′ lat, to evaluate diastolic function in intensive care unit patients. Indices, such as E/e′, may be of interest in these cases. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012 (Source: Journal of Clinical Ultrasound)

Treatment of septic shock with continuous HDF using 2 PMMA hemofilters for enhanced intensity.

The International Journal of Artificial Organs — Fri, 27 Jan 2012 05:00:00 +0100

Conclusion: Enhanced intensity PMMA-CHDF may improve hemodynamics and survival rate in patients with refractory septic shock. PMID: 22287204 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)

Functional Status Does Not Predict Complicated Clinical Course in Older Adults in the Emergency Department with Infection

Journal of the American Geriatrics Society — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionFor older adults admitted to the ED with infection, functional status did not predict complicated clinical course, but several other variables were predictive, including immunosuppression, several variables associated with hypoperfusion, and suspected bloodstream infection. Emergency physicians could consider these variables as potential indicators of complicated clinical course when making disposition decisions for this population. (Source: Journal of the American Geriatrics Society)

Changing Pattern of Perinatal Brain Injury in Term Infants in Recent Years

Pediatric Neurology — Fri, 27 Jan 2012 01:46:49 +0100

Abstract: Perinatal brain injury in term infants remains a significant clinical problem. Recently a change appears to have occurred in the pattern of such injuries. We sought to characterize the incidence, etiology, clinical manifestations, and outcomes of these injuries. A retrospective chart review identified clinical characteristics of neuroimaging, electroencephalography, and placental pathologic findings. Perinatal depression was defined as hypotonia and the need for respiratory support. From January 2004-December 2009, 29,597 term deliveries occurred. Brain injuries in 33 infants (live term births) included hypoxic-ischemic encephalopathy (n = 8; 0.27/1000), subdural hemorrhage (n = 10; 0.34/1000), intraventricular/intraparenchymal hemorrhage (n = 5; 0.17/1000), and focal cerebral...

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Letters: Transparency needed on donors to climate sceptic lobby

Guardian Unlimited Science — Thu, 26 Jan 2012 21:00:06 +0100

Science is by its nature sceptical: scientists interrogate information and only on repeated investigation does data become science. The science of climate change has been established through numerous high-profile studies (IPCC, NOAA, Nasa) and was even verified by the sceptic-led Best report. In 2009 one of the world's leading medical journals, the Lancet, declared climate change "the biggest global health threat of the 21st century". Denying the links between greenhouse gas emissions and man-made climate change is akin to denying the links between HIV/Aids and unprotected sex, smoking and lung cancer, or alcohol consumption and liver disease. In each of these cases, well-funded deniers have had to be exposed and confronted before appropriate health-promoting legislation was put in place.T...

Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions.

Obstetrics and Gynecology — Thu, 26 Jan 2012 20:43:50 +0100

CONCLUSION: : In this obstetric population, the leading reason for ICU admissions was cardiac disease. The increasing prevalence of advanced maternal age, congenital heart disease, obesity, diabetes, and hypertension among women who are of childbearing age may be contributing factors. LEVEL OF EVIDENCE: : III. PMID: 22270275 [PubMed - in process] (Source: Obstetrics and Gynecology)

High inferior vena cava thrombosis in a 16-year-old postpartum patient: A case report

Journal of Huazhong University of Science and Technology -- Medical Sciences -- — Thu, 26 Jan 2012 16:50:14 +0100

Summary Postpartum inferior vena cava (IVC) thrombosis is a rare, but potentially life-threatening disorder. Here we reported one case of the youngest woman to date who presented with massive IVC thrombus extending from deep veins of the right leg to the level of the 11th thoracic vertebra, associated with asymptomatic pulmonary embolism. Content Type Journal ArticlePages 149-150DOI 10.1007/s11596-012-0027-5Authors Yong Wei, Department of Cardiovasology, Shanghai Jiao Tong University, Shanghai, 201600 ChinaPing Ouyang, Department of Cardiovasology, Shanghai Jiao Tong University, Shanghai, 201600 ChinaWanhua Yang, Department of General Intensive Care Unit, Songjiang Branch to Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 201600 China ...

Myasthenia Gravis in Pregnancy: A Case Report

Clinical and Developmental Immunology — Thu, 26 Jan 2012 11:22:23 +0100

Conclusion. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management. (Source: Clinical and Developmental Immunology)

Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is no evidence that the use of quantitative cultures of respiratory secretions results in reduced mortality, reduced time in ICU and on mechanical ventilation, or higher rates of antibiotic change when compared to qualitative cultures in patients with VAP. Similar results were observed when invasive strategies were compared with non-invasive strategies. PMID: 22258968 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Pharmacokinetics and Pharmacodynamics of Piperacillin-Tazobactam in 42 Patients Treated with Concomitant CRRT.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 26 Jan 2012 05:00:00 +0100

ConclusionsThere is significant patient to patient variability in pharmacokinetic/pharmacodynamic parameters in patients receiving continuous renal replacement therapy. Many patients did not achieve pharmacodynamic targets, suggesting that therapeutic drug monitoring might optimize therapy. PMID: 22282479 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

The Epidemiology of Intensive Care Unit Readmissions in the United States.

American Journal of Respiratory and Critical Care Medicine — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSIONS: Approximately 2% and 4% of ICU patients discharged to the ward are readmitted within 48 and 120 hours, within a median time of 3 days. Medical patients in academic hospitals are more likely to be readmitted than patients in community hospitals without residents. ICU readmission rates could be useful for policy makers and investigations into their causes and consequences. PMID: 22281829 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Anemia in Critical Illness: Insights into Etiology, Consequences and Management.

American Journal of Respiratory and Critical Care Medicine — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Hayden SJ, Albert TJ, Watkins TR, Swenson ER Abstract Anemia is common in the intensive care unit (ICU), and may be associated with adverse consequences. However, current options for correcting anemia are not without problems and presently lack convincing efficacy for improving survival in critically ill patients. In this article we will review normal red blood cell (RBC) physiology, etiologies of anemia in the ICU , its association with adverse outcomes, and the risks, benefits, and efficacy of various management strategies, including blood transfusion, erythropoietin, blood substitutes, iron therapy, and minimization of diagnostic phlebotomy. PMID: 22281832 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

[Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure.]

Anadolu Kardiyol Der... — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome. PMID: 22281792 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Emergence and spread of a multidrug-resistant Acinetobacter baumannii clone producing both the OXA-23 carbapenemase and the 16S rRNA methylase ArmA.

Journal of Medical Microbiology — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Brigante G, Migliavacca R, Bramati S, Motta E, Nucleo E, Manenti M, Migliorino G, Pagani L, Luzzaro F, Viganò FE Abstract Acinetobacter baumannii is a Gram-negative organism reported worldwide as a cause of health care associated infections, particularly in Intensive Care Units (ICUs). The aim of the study was to describe the emergence and spread of carbapenem-resistant A. baumannii (CRAB) isolates in hospitalized patients. From March to November 2009, multidrug-resistant CRAB isolates were obtained from 21 patients hospitalized in different wards (mostly ICUs). Antimicrobial susceptibility was determined by the Etest method. Carbapenem and aminoglycoside resistance determinants were studied by PCR and sequencing. Genetic relatedness was investigated by pulsed-field gel e...

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Intensive Care Unit-Acquired Weakness.

Physical Therapy — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Nordon-Craft A, Moss M, Quan D, Schenkman M Abstract Patients admitted to the intensive care unit (ICU) can develop a condition referred to as ICU-acquired weakness. This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. ICU-acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations often requiring physical assistance for even the most basic activities associated with bed mobility. Many of these individuals have activity limitations months to years after hospitalization. The purpose of this article is to review evidence that guides physical rehabilitation of people with ICU-acquired weakness. In...

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention.

Braz J Med Biol Res — Thu, 26 Jan 2012 05:00:00 +0100

Authors: Carmona F, Prado SI, Silva MF, Gaspar GG, Bellissimo-Rodrigues F, Martinez R, Matsuno AK, Carlotti AP PMID: 22267005 [PubMed - as supplied by publisher] (Source: Braz J Med Biol Res)

Clinical experience with a new endobrochial blocker: the EZ-blocker

Journal of Anesthesia — Wed, 25 Jan 2012 18:13:54 +0100

Conclusions Use of the EZ-blocker is easy and safe. The short insertion time and short lung deflation time through the lumen of the SLT allows its use in emergency situations or in cases of a difficult airway. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00540-011-1315-0Authors Tamás Végh, Department of Anesthesiology and Intensive Care, Medical and Health Science Centre, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, HungaryMarianna Juhász, Department of Anesthesiology and Intensive Care, Medical and Health Science Centre, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, HungaryAttila Enyedi, Institute of Surgery, Department of Thoracic Surgery, Medical and Health Science Centre, University of Debrecen, Nagyerdei kr...

Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)

Intensive Care Medicine — Wed, 25 Jan 2012 18:07:29 +0100

Conclusion This document contains nine indicators, all of which have a high level of consensual agreement from an international Task Force, which could be used to improve quality in routine intensive care practice. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2462-3Authors A. Rhodes, Department of Intensive Care Medicine, St George’s Healthcare NHS Trust and St George’s University of London, London, SW17 0QT UKR. P. Moreno, Unidade de Cuidados Intensivos Polivalente, Hospital de St. António Dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E, Lisbon, PortugalE. Azoulay, Service de Réanimation Médicale, Hôpital Saint-Louis, Université Paris 7, 1 Avenue Claude Vellefaux, 75010 Paris, FranceM. Capuzzo, Section of Anaesthesio...

Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock?

Intensive Care Medicine — Wed, 25 Jan 2012 18:07:28 +0100

Conclusions Changes in MAP do not reliably track changes in CI after fluid challenge in patients with septic shock and, consequently, should be interpreted carefully when evaluating the response to fluid challenge in such patients. Content Type Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2457-0Authors Charalampos Pierrakos, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumDimitrios Velissaris, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumSabino Scolletta, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels,...

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Time course of metabolic activity and cellular infiltration in a murine model of acid-induced lung injury

Intensive Care Medicine — Wed, 25 Jan 2012 18:07:27 +0100

Conclusions This study demonstrated that PET imaging is a valid means of tracking the inflammatory response, also in longitudinal studies. Moreover, a correlation was found between persistence of the inflammatory response and fibrotic evolution of the injury. Content Type Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-011-2456-1Authors Vanessa Zambelli, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalyGiuseppe Di Grigoli, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, ItalyMargherita Scanziani, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalySilvia Valtorta, Tecnomed Foundation, Foundation of Universi...

New NICU space will provide more beds and increase access

Alberta.ca from- Health and Wellness — Wed, 25 Jan 2012 15:00:00 +0100

Up to 14 new neonatal intensive care unit (NICU) beds will be added at the Alberta Children’s Hospital to help meet the growing needs for these services in Calgary and southern Alberta. (Source: Alberta.ca from- Health and Wellness)

Syndrome of inappropriate antidiuretic hormone associated with moxifloxacin.

American Journal of Health-System Pharmacy : AJHP — Wed, 25 Jan 2012 14:49:21 +0100

Conclusion A 66-year-old woman developed severe hyponatremia after receiving moxifloxacin for five days for treatment of COPD exacerbation. PMID: 22261943 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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Revista Iberoamericana de Micologia — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSION: In this study, C. albicans was the most frequently detected species in candidiasis and risk exposures increased the susceptibility of hospitalized patients to acquiring a nosocomial infection by Candida spp. PMID: 22285886 [PubMed - as supplied by publisher] (Source: Revista Iberoamericana de Micologia)

MedWorm: Intensive Care

Single Course of Antenatal Steroids Did Not Alter Cortisol in Preterm Infants to 18 months

Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) group

Lung recruitment in ARDS - we are still confused, but on a higher PEEP level

Acute pulmonary oedema in chronic dialysis patients admitted into an intensive care unit

Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy

Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients

Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

A handoff is not a telegram: understanding of the patient is co-constructed

Sepsis and septic shock: the potential for gene arrays

Humidifiers during noninvasive mechanical ventilation

Inflammasome and caspase-1 inhibition caused by Bcl-2 and Bcl-XL may influence cytokine responses of lipopolysaccharide stimulated peripheral blood mononuclear cells from septic patients

Correction: Screening and control of methicillin-resistant Staphylococcus aureus in 186 intensive care units: different situations and individual solutions

Costs and benefits of rapid screening of methicillin-resistant Staphylococcus aureus carriage in intensive care units: a prospective multicenter study

Family nurture intervention (FNI): methods and treatment protocol of a randomized controlled trial in the NICU

Clarification of Conflict of Interest Disclosures in: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes [Correction]

Incorrect Work Group Name in: Enteral Omega-3 Fatty Acid, {gamma}-Linolenic Acid, and Antioxidant Supplementation in Acute Lung Injury [Correction]

Laparoscopic versus Open Colectomy for Colon Cancer in an Older Population: A Cohort Study

The sensitivity of neutrophil CD64 expression as a biomarker of bacterial infection is low in critically ill patients

Impact of Interhospital Transfer on Complications and Outcome After Intracranial Hemorrhage

Science Weekly podcast: Transplants and the future of intensive care

Drotrecogin alfa (activated) ... a sad final fizzle to a rollercoaster party

The risk factors for the prognosis of acute kidney injury under AKIN definition: a retrospective, multicenter study in critically ill patients

Poor Outcomes at Discharge Among Extremely Premature Infants: A National Population-Based Study [Article]

Fifty Years of Work on the Artificial Placenta: Milestones in the History of Extracorporeal Support of the Premature Newborn

Optimization of oxygen delivery during high-risk surgery: keep the concept but refining goals for inotrope infusion?

Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial [Caring for the Critically Ill Patient]

Nutrition for Critically Ill Patients: How Much Is Enough? [Editorial]

Hinchingbrooke: a private solution for a hospital in intensive care

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients

Talin, Vinculin and Nestin Expression in Orofacial Muscles of Dystrophin Deficient mdx Mice

Continuous Near-Infrared Regional Cerebral Perfusion Monitoring Shows Promise in Stroke Patients

Making the move: from bedside to camera-side

Evaluation of exercise capacity using wave intensity in chronic heart failure with normal ejection fraction

Sepsis-induced acute kidney injury—is there a lack of energy?

Renal bioenergetics during early gram-negative mammalian sepsis and angiotensin II infusion

Brain Tissue Oxygenation and Cerebral Perfusion Pressure Thresholds of Ischemia in a Standardized Pig Brain Death Model

Enhancing Braden pressure ulcer risk assessment in acutely ill adult veterans

A prospective randomized open-label crossover trial of regional citrate anticoagulation vs. anticoagulation free liver dialysis by the Molecular Adsorbents Recirculating System

St. Elizabeth denied NICU unit

Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery

Contrast-induced acute kidney injury: what is the prevalence of prevention protocols?

Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction

Acute Treatment Options for Spinal Cord Injury

Sepsis Immunopathology: Perspectives of Monitoring and Modulation of the Immune Disturbances

Anti-Xa Levels 4 h After Subcutaneous Administration of 5,700 IU Nadroparin Strongly Correlate with Lean Body Weight in Morbidly Obese Patients

Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

The neonate presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Renal Replacement Therapy in Cardiology Wards: Changing Trends in a Transitional Country

Treatment of Neurocritical Care Emergencies in Pregnancy

Validation of the Better Care® system to detect ineffective efforts during expiration in mechanically ventilated patients: a pilot study

Ineffective efforts during mechanical ventilation: the brain wants, the machine declines

Review of Inhaled Nitric Oxide in the Pediatric Cardiac Surgery Setting

MCQs

Drugs and the liver

Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motility

Central nervous system stimulants: basic pharmacology and relevance to anaesthesia and critical care

Digestion and absorption

Gut motility and its control

The mouth, stomach and intestines

Metabolic functions of the liver

Functional anatomy and blood supply of the liver

Anaesthesia and minimally invasive surgery

Laboratory tests in hepatic failure

Clinical aspects of hepatic disease

Anaesthesia for gastrointestinal surgery

Editorial Board

Contents

A model program for perinatal palliative services.

Implementing practice guidelines and education to improve care of infants with neonatal abstinence syndrome.

Enteral Feeding Practices in the NICU: Results from a 2009 Neonatal Enteral Feeding Survey.

The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit: NANN Position Statement #3052.

Validation of frontal near-infrared spectroscopy as noninvasive bedside monitoring for regional cerebral blood flow in brain-injured patients.

Editorial Board

Table of Contents

Intensive care admissions and outcome at the University of Calabar Teaching Hospital, Nigeria

2011 Reviewers

2011—year in review

Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI)

Pulmonary complications after major head and neck surgery: A retrospective cohort study