Intensive care medicine
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Intensive care medicine · Nov 2009
Randomized Controlled Trial Multicenter StudyThe effects of etomidate on adrenal responsiveness and mortality in patients with septic shock.
Use of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality. In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate. ⋯ The use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with an increase in mortality. We recommend clinicians demonstrate extreme caution in the use of etomidate in critically ill patients with septic shock.
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Intensive care medicine · Nov 2009
Comparative StudyDetection of carbon dioxide thresholds using low-flow sidestream capnography in ventilated preterm infants.
Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants. ⋯ Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest.
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Intensive care medicine · Nov 2009
Assessment of pro-vasopressin and pro-adrenomedullin as predictors of 28-day mortality in septic shock patients.
Improvements in survival after septic shock will most likely rely on our capacity to manage individualized therapies based on the measurement of rapidly accessible biomarkers. As the early phase of septic shock is dominated by severe alterations of the cardiovascular system, the predictive value for mortality of pro-vasopressin (pro-AVP) and pro-adrenomedullin (pro-ADM), two vasoactive pro-hormones, was assessed. ⋯ Both Pro-ADM and pro-AVP appear to be good biomarkers for the prediction of 28-day mortality after septic shock. However, their association in a single variable tends to improve their predictive capacity.
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Intensive care medicine · Nov 2009
Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation.
Lipoproteins modulate vascular cell function in inflammation. In this study, we analyzed whether plasma concentrations of lipoproteins and apolipoproteins in human sepsis are related to patient survival and the activation of blood monocytes and platelets. ⋯ Low apo-AI is independently related to 30-day mortality in human sepsis and the decrease in apo-AI/HDL cholesterol correlates to increased platelet activation. Moreover, changes in apolipoproteins supposed to modulate lipopolysaccharide effects, such as apo-CI and apo-E, correlate to monocyte activation.