2,833 publications from this institution
Animal studies suggest a life-saving benefit for intra-arrest cooling. Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. A 200-patient study showed transnasal cooling to be a safe and feasible method of intra-arrest cooling. The study also showed a solid trend to improved neurologically intact survival rates in those patients receiving intra-arrest transnasal cooling.
info:eu-repo/semantics/published
We investigated the possible differences in epidemiology, clinical course, management, and outcome between early and late occurrence of shock using data from the Sepsis Occurrence in Acutely Ill Patients Study, a large European multicenter study, which prospectively collected data from all adult intensive care unit (ICU) patients admitted to a participating center within a 2-week period in 2002. Shock was defined as hemodynamic compromise necessitating the administration of vasopressor agents. Early and late shock were defined as onset of shock within the first 2 days in the ICU or later, respectively. Of 3,147 patients, 1,058 (33.6%) had shock at any time, of whom 462 (43.7%) had septic shock. Patients with late shock had a higher incidence of respiratory (87.4 vs. 69.7%, P < 0.001) and hepatic (15.5 vs. 8.7%, P < 0.05) failure, and more often received dopamine (44.7% vs. 34.5%, P < 0.05) and albumin (31.1% vs. 20.3%, P < 0.001) than patients who developed shock early. Intensive care unit and hospital mortality rates were greater in patients who developed shock late, rather than early (52.4% vs. 36.8% and 55.3% vs. 43%, respectively, P < 0.02). In a multivariable analysis, late shock was associated with an independent risk of higher ICU mortality in shock patients (odds ratio, 2.6; 95% confidence interval, 1.6-4.3, P < 0.001). These observations have important implications in establishing individual prognosis as well as in the design and interpretation of clinical trials.
info:eu-repo/semantics/published
info:eu-repo/semantics/published
This large pan-European study documents the high frequency of sepsis in critically ill patients and shows a close relationship between the proportion of patients with sepsis and the intensive care unit mortality in the various countries. In addition to age, a positive fluid balance was among the strongest prognostic factors for death. Patients with intensive care unit acquired sepsis have a worse outcome despite similar severity scores on intensive care unit admission.
Introduction Septic patients frequently develop critical illness myopathies (CIMs) that may represent a crucial factor for prolonged intensive care unit treatment and for ventilator weaning delay. Experimental fi ndings have identifi ed that oxidative stress plays a role in causing muscle depletion in chronic pathological states like sepsis. It is well documented that regular moderate physical exercise can decreased oxidative stress and enhance antioxidant functions. Objective To investigate whether exercise training reduces oxidative damage in septic rats induced by cecal ligation and perforation (CLP). Methods Wistar rats were randomly assigned to three groups: Sham (submitted to a fake surgery), CLP, and CLP that was previously trained (CLPT). The exercise training protocol consisted of 8 weeks of running on a treadmill, 5 days/week, for 60 minutes at 60% of the maximal running speed obtained on the graded treadmill test. Rats were subjected to CLP surgery; after 120 hours of surgical procedure they were killed by decapitation. Oxidative damage of lipids (thiobarbituric acid reactive species (TBARS)) and proteins (carbonyl groups) were analyzed in Soleus (type I fi ber) and plantaris (type II fi ber) muscles. Results See Table
There was broad agreement among the roundtable participants regarding a number of explicit opportunities for the improvement of clinical trials in critical care.
Abdominal compartment syndrome may be defined as the deleterious pathophysiologic consequences of a significant increase in intra-abdominal pressure. These alterations can affect respiratory mechanics, cardiovascular system, regional blood flow, renal function, urine output, and intracranial pressure. Although the syndrome may be associated with many clinical situations, the most common are severe abdominal trauma and ruptured abdominal aortic aneurysm. Diagnosis depends upon recognition of the clinical syndrome followed by an objective measurement of intraabdominal pressure, the most common being the measurement of bladder pressure. Treatment consists of adequate fluid resuscitation and surgical decompression when necessary.
