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Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Our data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS.Trial registration: ISRCTN14110527 (Source: Critical Care)
Source: Critical Care - November 20, 2009 Category: Intensive Care Authors: Wusi QiuChenchen GuoHong ShenKeyong ChenLiang WenHongjie HuangMin DingLi SunQizhou JiangWeiming Wang Source Type: journals

Severe Influenza A (H1N1)v in patients without any known risk factorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In Rello et al work 15 out of 32 critical pandemic flu patients did not have any risk factor. A further analysis in this subgroup of patients is needed. Antiviral treatment delay or any other management event differences perhaps were responsible for progressive illness. This data may help management in initial care of pandemic flu patients. (Source: Critical Care)
Source: Critical Care - November 19, 2009 Category: Intensive Care Authors: Carles Alonso-TarresCristina Cortes-LletgetSara PintadoAssumpta Ricart Source Type: journals

Presentation and management of critically ill patients with Influenza A (H1N1) influenza - a UK perspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A report of the demographics, presentation and management of patients with influenza A (H1N1) in a general adult intensive care unit in the United Kingdom. (Source: Critical Care)
Source: Critical Care - November 19, 2009 Category: Intensive Care Authors: Joyce YeungMark BaileyGavin PerkinsFang Gao Smith Source Type: journals

The leading causes of death after burn injury in a single pediatric burn centerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
IntroductionSevere thermal injury is characterized by profound morbidity and mortality. Advances in burn and critical care, including early excision and grafting, aggressive resuscitation and advances in antimicrobial therapy have made substantial contributions to decrease morbidity and mortality. Despite these advances, death still occurs. Our aim was to determine the predominant causes of death in burned pediatric patients in order to develop new treatment avenues and future trajectories associated with increased survival. Methods: Primary causes of death were reviewed from 144 pediatric autopsy reports. Percentages of p...
Source: Critical Care - November 17, 2009 Category: Intensive Care Authors: Felicia WilliamsDavid HerndonHal HawkinsJong LeeRobert CoxGabriela KulpCeleste FinnertyDavid ChinkesMarc Jeschke Source Type: journals

The Value of a Risk Model for Early-onset CandidemiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Blood stream infections from Candida species are associated with an increased length of stay, increased hospital costs, and higher mortality when compared to bacterial blood stream infections. Delayed or inappropriate therapy in candidemia leads to increased mortality, thus early recognition becomes paramount. With biomarkers showing promise, blood cultures still remain the gold standard but require 24-72 hours for growth. Thus, the reliance on epidemilogic risk factors for the initiation of empiric antifungal therapy provides the best method for early appropriate therapy. Shorr and colleagues have devised a risk score to ...
Source: Critical Care - November 16, 2009 Category: Intensive Care Authors: Christian SandrockJaveed Siddqui Source Type: journals

Ventilator-induced endothelial activation and inflammation in the lung and distal organsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Our data implicate that MV causes endothelial activation and inflammation in mice without pre-existing pulmonary injury, both in the lung and distal organs. (Source: Critical Care)
Source: Critical Care - November 16, 2009 Category: Intensive Care Authors: Maria HegemanMarije HennusCobi HeijnenPatricia SpechtBurkhard LachmannNicolaas JansenAdrianus van VughtPieter Cobelens Source Type: journals

Sepsis and multiple organ failure represent a chaotic adaptation to severe stress which must be controlled at nano-scaleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We claim that sepsis and multiple organ failure represent an adaptive process that aims a survival advantage. Dynamic nature of sepsis comprise all of the key properties of a chaotic system. Chaotic and complex systems actually aim order and integrity, and their behaviours cannot be explained by linear statistical methods. That's why pathophysiology of sepsis and multiple organ failure must be re-modeled within the context of chaos and complexity theories. We also claim that one of the underlying reasons of difficulty in bench to bedside transition of experimental data is the difficulty in applying therapies at the propose...
Source: Critical Care - November 12, 2009 Category: Intensive Care Authors: Yusuf KilicIlke KilicMesut Tez Source Type: journals

Unraveling the Role of HMGB1 in Severe TraumaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
High mobility group box protein (HMGB1) has been shown to participate in acute inflammatory reactions, including acute lung injury and sepsis. There is also evidence that circulating levels of HMGB1 are increased after severe trauma and are associated with clinically important outcome parameters, including mortality. Recent studies demonstrated that HMGB1 itself has little or no proinflammatory activity, but is able to potentiate inflammatory responses through binding to mediators, such as endotoxin or cytokines. Important questions are to determine the binding partners for HMGB1 in the setting of severe injury and whether...
Source: Critical Care - November 12, 2009 Category: Intensive Care Authors: Edward Abraham Source Type: journals

A Proposed Algorithm for Initiation of Renal Replacement Therapy in Adult Critically Ill PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this algorithm is to provide a starting point to guide clinicians on when to initiate RRT in critically ill adult patients. In addition, the proposed algorithm is intended to provide a foundation for prospective evaluation and the development of a broad consensus on when to initiate RRT in critically ill patients. (Source: Critical Care)
Source: Critical Care - November 11, 2009 Category: Intensive Care Authors: Sean BagshawDinna CruzNoel GibneyClaudio Ronco Source Type: journals

Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer less invasive techniques. For these purposes, the transpulmonary thermodilution technique (TPT) allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. But these metrics remain relatively untested in heart failure. In this issue of Critical Care, Ritter and colleagues compare metrics of TPT to the PAC in patients with acute heart ...
Source: Critical Care - November 11, 2009 Category: Intensive Care Authors: Christopher VernonCharles Phillips Source Type: journals

Weakness in the ICU: A call to actionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Muscle weakness is prevalent in critically ill patients and can have a dramatic effect on short and long term outcomes, yet there are currently no interventions with proven efficacy in preventing or treating this complication. In a new randomized trial, researchers found that serial electrical muscle stimulation significantly mitigated ultrasound-defined muscle atrophy, and the treatment was not linked to adverse effects. Although preliminary, these results, together with other recent studies, indicate a paradigm shift to a more proactive approach in managing neuromuscular complications in the ICU. (Source: Critical Care)
Source: Critical Care - November 9, 2009 Category: Intensive Care Authors: Robert StevensNicholas HartBernard de JongheTarek Sharshar Source Type: journals

Is the Way to Man's Heart (and Lung) Through the Abdomen?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Intra-abdominal hypertension (IAH) is increasingly recognized to be both prevalent and clinically important in medical and surgical ICUs. Intra-abdominal pressure (IAP) can impact organ function throughout the body, and it can also complicate standard measurements used in ICU care. The article by Krebs et al. reports the effect of IAP on respiratory function, gas exchange and hemodynamic function. Their results show a relatively small effect of modestly elevated IAP on these variables in their patient population. However, their work raises several questions for clinicians and researchers regarding the pathophysiology and m...
Source: Critical Care - November 6, 2009 Category: Intensive Care Authors: Robert OwensRobert HarrisAtul Malhotra Source Type: journals

Anaesthesia in septic patients: good preparation and making the right choice?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Septic patients may require anaesthesia for surgery or to facilitate endotracheal intubation for respiratory failure. These patients frequently start with a deranged haemodynamic state including vasodilation with hypotension, and cardiomyopathy, making induction of anaesthesia a potentially hazardous task. Anaesthetic agents are well known to decrease contractility and cause vasodilation, in part from direct effect of the drugs, and in part due to the "state of anaesthesia" which causes reduced sympathetic tone. Before induction, the physician should understand the haemodynamic state (especially using echocardiography), re...
Source: Critical Care - November 6, 2009 Category: Intensive Care Authors: Colin Royse Source Type: journals

Multidisciplinary care for tracheostomy patients: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported. These results should be interpreted with caution due to the methodological weaknesses in the historical control studies. (Source: Critical Care)
Source: Critical Care - November 6, 2009 Category: Intensive Care Authors: Marie GarrubbaTari TurnerClare Grieveson Source Type: journals

Early release of high mobility group box nuclear protein 1 after severe trauma in humans: role of injury severity and tissue hypoperfusionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: The results of this study demonstrate for the first time that HMGB1 is released into the bloodstream early after severe trauma in humans. The release of HMGB1 requires severe injury and tissue hypoperfusion, and is associated with posttraumatic coagulation abnormalities, activation of complement and severe systemic inflammatory response. (Source: Critical Care)
Source: Critical Care - November 4, 2009 Category: Intensive Care Authors: Mitchell CohenKarim BrohiCarolyn CalfeePamela RahnBrian ChesebroSarah ChristiaansMichel CarlesMarybeth HowardJean-Francois Pittet Source Type: journals

Risk factors for acute respiratory distress syndrome during neutropenia recovery in patients with hematologic malignanciesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery. (Source: Critical Care)
Source: Critical Care - November 3, 2009 Category: Intensive Care Authors: Chin Kook RheeJi Young KangYong Hyun KimJin Woo KimHyung Kyu YoonSeok Chan KimSoon Suk KwonYoung Kyoon KimKwan Hyung KimHwa Sik MoonSung Hak ParkHee Je KimSeok LeeJeong Sup Song Source Type: journals

Decrease of CD4 lymphocytes and apoptosis of CD14 monocytes are characteristic alterations in sepsis caused by ventilator-associated pneumonia: results from an observational studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Decrease of CD4-lymphocytes and immunoparalysis of monocytes are characteristic alterations of sepsis arising in the field of VAP. (Source: Critical Care)
Source: Critical Care - November 2, 2009 Category: Intensive Care Authors: Aimilia PelekanouIraklis TsagkarisAntigoni KotsakiVassiliki KaragianniHelen GiamarellouApostolos ArmaganidisEvangelos Giamarellos-Bourboulis Source Type: journals

Volume responsiveness in ICU patients: who is fluid responsive?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No Abstract. (Source: Critical Care)
Source: Critical Care - October 30, 2009 Category: Intensive Care Authors: Jasper Van BommelEva Klijn Source Type: journals

Changes in serum creatinine in the first 24 hours after cardiac arrest indicate prognosis: an observational cohort studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: In this large cohort of patient after cardiac arrest, we found that AKI occurs in nearly 50% of patients when the new criteria are applied. Patients with unfavourable neurological outcome are affected more frequently. A significant association between the development of AKI and NSE levels indicating hypoxic brain damage was observed. Our data show that changes in serum creatinine may contribute to the prediction of outcome in patients with cardiac arrest. Whereas a decline in serum creatinine (> 0.2 mg/dL) in the first 24 hours after cardiac arrest indicates good prognosis, the risk of unfavourable outcome is ...
Source: Critical Care - October 29, 2009 Category: Intensive Care Authors: Dietrich HasperStephan von HaehlingChristian StormAchim JorresJoerg Schefold Source Type: journals

A retrospective cohort pilot study to evaluate a triage tool for use in a pandemicEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Refinement of the triage protocol and implementation is required prior to future study, including improved training of triage officers, and protocol modification to minimize the exclusion from critical care of patients who may in fact benefit. However, our results suggest that the triage protocol can help to direct resources to patients who are most likely to benefit, and help to decrease the demands on critical care resources, thereby making available more resources to treat other critically ill patients. (Source: Critical Care)
Source: Critical Care - October 29, 2009 Category: Intensive Care Authors: Michael ChristianCindy HamielecNeil LazarRandy WaxLauren GriffithMargaret HerridgeDavid LeeDeborah Cook Source Type: journals

Swine flu - Provision of ventilation in a "worst case scenario"Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Editor,As a busy intensive care unit at a district general hospital in the UK, we are intrigued by the "worst case scenario" plans for swine flu in our region and the ubiquitous algorithms that form part of this planning.A Department of Health document suggests for the purposes of planning that, during a first major UK pandemic wave, the peak clinical attack rate per week would be 8% [1]. Of these patients, hospitalization rate would be 2% and of these 25% would require intensive care "if the capacity exists"Our hospital serves a population of 220,000. In our region, these estimates suggest that 352 patients will require h...
Source: Critical Care - October 28, 2009 Category: Intensive Care Authors: Alex DoyleJoseph CarterPeter Young Source Type: journals

Recently Published Papers : Novel therapies in COPD, Cardiac chemicals & Intensive Care OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The burden of chronic obstructive pulmonary disease (COPD) on intensive care is heavy, but newer modalities of treatment are now available to improve outcomes. Cardiac based research continues to generate new drugs and tests to better outcome and aid in early diagnosis. And how do various intensive care interventions compare in improving clnical & functional outcomes? (Source: Critical Care)
Source: Critical Care - October 27, 2009 Category: Intensive Care Authors: Gareth Williams Source Type: journals

Goal directed therapy in high risk surgical patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A small group of patients account for most of the operative morbidity and mortality. These "high-risk" patients do badly as they are unable to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri operative period their outcomes can be improved. This goal directed therapy includes the use of fluid loading and inotropes, originally with the aid of the pulmonary artery catheter but more recently with less invasive flow monitoring devices. Despi...
Source: Critical Care - October 26, 2009 Category: Intensive Care Authors: Nicholas LeesMark HamiltonAndrew Rhodes Source Type: journals

beta-Adrenergic modulation in sepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Sepsis, despite recent therapeutic progress, still carries unacceptably high mortality rates. The adrenergic system, a key modulator of organ function and cardiovascular homeostasis, could be an interesting new therapeutic target for septic shock. β-Adrenergic regulation of the immune function in sepsis is complex and is time dependent. However, β2 activation as well as β1 blockade seems to downregulate proinflammatory response by modulating the cytokine production profile. β1 blockade improves cardiovascular homeostasis in septic animals, by lowering myocardial oxygen consumption without altering organ perfusion, and ...
Source: Critical Care - October 22, 2009 Category: Intensive Care Authors: Etienne de MONTMOLLINJérome ABOABArnaud MansartDjillali Annane Source Type: journals

Coming soon to an ICU near you: Severe Pandemic Influenza in ICU Patients in SpainEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A novel strain of swine influenza A H1N1 has already disseminated worldwide and has become a major clinical problem for intensive care units in selected areas. Many regions in the Southern Hemisphere are currently struggling to keep up with the influx of severely affected patients with acute respiratory failure from primary influenza pneumonia. The Northern hemisphere is bracing for a similar surge of patients over the next winter's influenza season. This initial report of ventilatory needs for patients with severe influenza pneumonia in Spanish ICUs provides a useful guide of what to expect, and how to respond to the chal...
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Steven Opal Source Type: journals

Routine Use of Weaning Predictors: Not so FastEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Weaning from mechanical ventilation remains a major challenge for critical care physicians. Because subjective criteria are inaccurate, objective measurements consisting of clinical criteria and physiologic tests, weaning predictors, have been used to facilitate decision making. An integrated weaning index calculated as the product of static compliance and arterial oxygen saturation divided by the frequency-tidal volume ratio appears to be more accurate than other currently available predictors. Despite the accuracy of this new test a beneficial effect on outcome is yet to be proven. (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Scott Epstein Source Type: journals

Year in review in critical care: sepsis research findings in 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
2008 was a significant year in critical care sepsis research with a number of landmark papers published showing highly promising and at times very disappointing clinical and laboratory findings reported in the last year. (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Steven Opal Source Type: journals

Year in review 2008: Critical Care - respirologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Original research contributions published in Critical Care in 2008 in the field of Respirology and Critical Care Medicine are summarized in this article. Eighteen articles were grouped into the following categories: acute lung injury and acute respiratory distress syndrome, mechanical ventilation, mechanisms of ventilator-induced lung injury, and tracheotomy decannulation and non-invasive ventilation. (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Art SlutskyHaibo Zhang Source Type: journals

Year in review 2008: Critical Care - traumaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Eleven papers on trauma published in Critical Care during 2008 addressed traumatic brain injury (TBI), burns, diagnostic concerns and immuno-suppression. Regarding TBI, preliminary results indicate the utility of both magnetic resonance imaging (MRI) or ultrasound in measuring optic nerve sheath diameter to identify elevated intracranial pressure (ICP) as well as the potential benefit of thiopental for refractory ICP. Another investigation demonstrated that early extubation of TBI patients whose Glasgow Coma Scale score was (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Jeffery MetzgerAlexander EastmanPaul Pepe Source Type: journals

Year in review in Critical Care, 2008: NephrologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We summarize original research in the field of critical care nephrology accepted or published in 2008 in Critical Care and, when considered relevant or directly linked to this research, inother journals. Three main topics have been identified for a rapid overview: 1) Classification of acute kidney injury with particular attention to differences and similarities between the RIFLE and AKIN classifications. 2) Fluid balance in patients requiring renal replacement therapy (RRT) has been showed as an independent risk factor for mortality in critically ill patients: current evidence and uncertainties are described. 3) Management...
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: zaccaria ricciclaudio ronco Source Type: journals

A year in review - Critical Care 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In 2008, the interest for metabolic and endocrine issues and their consequences in critically ill patients was high. A large proportion of the research papers related to these issues was related to the metabolism of glucose and its control, and to the changes in body composition including muscular weakness. In Critical Care, original reports from investigations of glucose physiology, and clinical data from observational and interventional studies were published. Important reports of the effects of hormone analogues, such as vasopressin and hydrocortisone and early antioxidants in selected subpopulations were also available...
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Jean-Charles Preiser Source Type: journals

Year in review 2008: Critical Care - cardiologyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We review key research papers in cardiology and intensive care published during 2008 in Critical Care. We quote studies on the same subject published in other journals if appropriate. Papers have been grouped into three categories: 1) cardiovascular biomarkers in critical illness; 2) haemodynamic management of septic shock, and 3) haemodynamic monitoring. (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Marius Terblanche Source Type: journals

Emergency Care of the AbusedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There are obstinate and unknown braves who defend themselves inch by inch in the shadows .... There are noble and mysterious triumphs which no eye sees. No renown rewards, and no flourish of trumpets salutes. Life, misfortune, isolation, abandonment, and poverty and battlefields which have their heroes.Victor Hugo (1802-1885)It requires more courage to suffer than to die.Napoleon Bonaparte (1769-1821) (Source: Critical Care)
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Laura Hawryluck Source Type: journals

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
IntroductionEarly structured resuscitation of severe sepsis has been suggested to improve short term mortality; however, no previous study has examined the long-term effect of this therapy. We sought to determine one-year outcomes associated with implementation of early goal directed therapy (EGDT) in the emergency department (ED) care of sepsis. Methods: We performed a longitudinal analysis of a prospective before and after study conducted at a large urban ED. Adult patients were enrolled if they had suspected infection, 2 or more systemic inflammatory response criteria, and either systolic blood pressure (SBP) 4 mM. Excl...
Source: Critical Care - October 20, 2009 Category: Intensive Care Authors: Michael PuskarichMichael MarchickJeffrey KlineMichael SteuerwaldAlan Jones Source Type: journals

Statin prophylaxis and inflammatory mediators following cardiopulmonary bypass: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: Although the RCT evidence may suggest a reduction in post-CPB inflammation by statin therapy, the evidence is not definitive due to significant limitations. Several of the trials were not methodologically rigorous and statin intervention was highly variable in this small number of studies. This systematic review demonstrates that there is a significant gap that exists in the current literature in regards to the potential anti-inflammatory effect of statin therapy prior to CPB. (Source: Critical Care)
Source: Critical Care - October 18, 2009 Category: Intensive Care Authors: Catherine MorganMichael ZappitelliPeter Gill Source Type: journals

Gastroesophageal reflux in mechanically ventilated pediatric patients and its relation to ventilator-associated pneumoniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Conclusions: GER is a constant incident in mechanically ventilated pediatric patients, with alkaline reflux being more common than acidic reflux. Both acidic and alkaline refluxes were found to be associated with the development of VAP and total reflux time was found to be a reliable predictor of VAP. Moreover, acidic reflux was found to be more related to mortality than alkaline reflux. (Source: Critical Care)
Source: Critical Care - October 18, 2009 Category: Intensive Care Authors: Tarek Abdel GawadMostafa El-HodhodHanan IbrahimYousef Michael Source Type: journals

Brachial Artery Flow Velocity Variation: Another victory for hand-carried ultrasound?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Dynamic predictors are clearly superior to static pressures in predicting whether a patient will respond to a fluid bolus. Hand-carried ultrasound (HCUS) can measure changes in blood flow velocity in the brachial artery which parallel arterial pulse pressure variation. The potential for HCUS to guide fluid therapy non-invasively must overcome problems of sensitivity and applicability. (Source: Critical Care)
Source: Critical Care - October 15, 2009 Category: Intensive Care Authors: Gregory Schmidt Source Type: journals

Computerized glucose regulation in the intensive care unit. How to create artificial control.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many intensive care units (ICU) implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycaemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (CDSS) use more complex logic to provide an insulin infusion rate based on previous blood glucoses and other parameters. A computerized CDSS for glucose control has the potential to reduce overall w...
Source: Critical Care - October 15, 2009 Category: Intensive Care Authors: Miriam HoekstraMathijs VogelzangEvkeny VerbitskiyMaarten Nijsten Source Type: journals

The Paradox of Ventilator-Associated Pneumonia Prevention MeasuresEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is a striking paradox in the literature supporting high profile measures to reduce ventilator-associated pneumonia (VAP): many show significant reductions in VAP rates but almost none show any impact on patients' duration of mechanical ventilation, length of stay in the intensive care unit and hospital, or mortality. The paradox is largely attributable to lack of specificity in the VAP definition. The clinical and microbiological criteria for VAP capture a population of patients with an array of conditions that range from serious to benign. Many of the benign events are manifestations of bacterial colonization superi...
Source: Critical Care - October 14, 2009 Category: Intensive Care Authors: Michael Klompas Source Type: journals

Severe Community Acquired Pneumonia: What should we predict?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Several aspects related to the definition of severe CAP and the design of prediction tools need to be addressed prior further attempts to predict severe CAP.What is the concept of severe CAP for? CAP severity could be based on pathophysiologic disorders that will allow physicians to objectively define severity. Alternatively, CAP severity could be based on treatment intensity that would certainly facilitate its uptake and the development of clinical tool to assist physicians' decision. This second approach that appears more clinically relevant will be assumed for the rest of this letter. (Source: Critical Care)
Source: Critical Care - October 14, 2009 Category: Intensive Care Authors: Bertrand Renaud Source Type: journals

Computerized intensive insulin dosing can mitigate hypoglycemia and achieve tight glycemic control when glucose measurement is performed frequently and on timeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We examined the use of a computerized insulin dosing algorithm to manage hyperglycemia with particular attention to frequency and conditions surrounding hypoglycemic events. Methods: This is a retrospective analysis of adult patients with hyperglycemia receiving intravenous (IV) insulin therapy from March 2006 to December 2007 in the intensive care units of 2 tertiary care teaching hospitals. Patients placed on a glycemic control protocol using the Clarian GlucoStabilizerTM IV insulin dosing calculator with a target range of 4.4-6.1 mmol/L were analyzed. Metrics included time to target, time in target, mean blood glucose +...
Source: Critical Care - October 11, 2009 Category: Intensive Care Authors: Rattan JunejaCorbin RoudebushStanley NasrawayAdam GolasJudith JacobiJoni CarrollDeborah NelsonVictor AbadSamuel Flanders Source Type: journals

The evolving story of medical emergency teams in quality improvementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Adverse events affect approximately 3% to 12% of hospitalized patients. At least a third, but as many as 50%, of such events are considered preventable. Detection of these events requires investments of time and money. A report in this issue of Critical Care used the medical emergency team activation as a trigger to perform a prospective standardized evaluation of charts. They observed that roughly one fourth of calls were related to a preventable adverse event, which compares to the previous literature. However, while previous studies relied on retrospective chart reviews, this study introduced the novel element of real-t...
Source: Critical Care - October 11, 2009 Category: Intensive Care Authors: Surayya Johar Source Type: journals

Are specialized ICUs so special?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No description available (Source: Critical Care)
Source: Critical Care - October 11, 2009 Category: Intensive Care Source Type: journals

Medical emergency teams and rapid response triggers - the ongoing quest for the "perfect" patient safety systemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
n/a(letter to the editor) (Source: Critical Care)
Source: Critical Care - October 8, 2009 Category: Intensive Care Authors: Philip StahelPhilip Mehler Source Type: journals

Bench-to-bedside review: Understanding the impact of resistance and virulence factors on MRSA infections in the ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Methicillin-resistant Staphylococcus aureus (MRSA) displays a remarkable array of resistance and virulence factors, which have contributed to its prominent role in infections of the critically ill. We are beginning to understand the function and regulation of some of these factors and efforts are ongoing to better characterize the complex interplay between the microorganism and host response. It is important that clinicians recognize the changing resistance patterns and epidemiology of Staphylococcus spp., as these factors may impact patient outcomes. CA-MRSA clones have emerged as an increasingly important subset of Staph...
Source: Critical Care - October 7, 2009 Category: Intensive Care Authors: Lee SkrupkyScott MicekMarin Kollef Source Type: journals

Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized studyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
IntroductionCritically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US). Methods: Forty-nine critically ill patients (age: 59 +/- 21 years) with an APACHE II admission ...
Source: Critical Care - October 7, 2009 Category: Intensive Care Authors: Vasiliki GerovasiliKonstantinos StefanidisKonstantinos VitzilaiosEleftherios KaratzanosPanagiotis PolitisApostolos KoroneosAikaterini ChatzimichailChristina RoutsiCharis RoussosSerafeim Nanas Source Type: journals

Terlipressin or Europressin?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Use of terlipressin in septic shock relies on a series of European studies resulting in a better knowledge of this vasopressive agent. Additional studies demonstrate that this agent appears to have attractive properties when administered properly. In comparison to prior reports, continuous infusion of low-dose terlipressin seems superior when administered to septic animals. For the first time in humans, Morelli et al. compared this mode of administration with other vasopressors. (Source: Critical Care)
Source: Critical Care - October 6, 2009 Category: Intensive Care Authors: Marc Leone Source Type: journals

Implementation of an evidence-based sepsis program in the intensive care unit: evident or not?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Severe sepsis and septic shock are one of the most serious health conditions and associated with unwelcome clinical, social, and economic outcome. With the introduction of the Surviving Sepsis Campaign guidelines, the campaign leaders aimed to reduce mortality from severe sepsis by at least one quarter by 2009, and this by means of a six-point action plan, respectively, building awareness among healthcare professionals, improving early and accurate disease recognition and diagnosis, increasing the use of appropriate treatments and interventions, education, getting better post-ICU access, and developing standard processes o...
Source: Critical Care - October 6, 2009 Category: Intensive Care Authors: Dominique VandijckStijn BlotDirk Vogelaers Source Type: journals

Acute transient thyroid swelling after catheterization of the subclavian veinEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this report, we present a remarkable case of acute diffuse edematous swelling of the thyroid gland as an unexpected and rare complication after attempted subclavian vein catheterization. Acute thyroid swelling rarely occurs after fine needle aspiration, and to our knowledge, we are the first to describe acute thyroid swelling after central venous catheter insertion. (Source: Critical Care)
Source: Critical Care - October 6, 2009 Category: Intensive Care Authors: R. Arthur BouwmanMartijn MeijerinkAlbertus Beishuizen Source Type: journals

Immunosedation: a Consideration for SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study, in addition to those by others, suggests there are disparate immunomodulating effects between sedatives. Clinical studies are warranted to investigate whether these effects impact outcomes of septic patients. Perhaps one day the choice of sedative in septic patients will not be based solely on sedative properties but rather immunosedative profiles. (Source: Critical Care)
Source: Critical Care - October 5, 2009 Category: Intensive Care Authors: Robert MacLaren Source Type: journals