Intensive care medicine
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Intensive care medicine · Feb 2010
Secondary decline of cerebral autoregulation is associated with worse outcome after intracerebral hemorrhage.
Blood pressure management in acute intracerebral hemorrhage (ICH) relies on functioning cerebral autoregulation. The time course of autoregulation in acute ICH and its relation with clinical outcome are not known. ⋯ Cerebral autoregulation is primarily preserved in acute ICH, but a secondary decline mainly ipsilateral to the ICH can occur. This is associated with poor clinical status, ventricular hemorrhage, lower cerebral perfusion pressure and worse clinical outcome.
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Intensive care medicine · Feb 2010
Incidence and prognosis of dysnatremias present on ICU admission.
Dysnatremias are common in patients admitted to the intensive care unit (ICU). Whether the presence of disorders of sodium balance on ICU admission is independently associated with excess mortality is unknown. We hypothesized that dysnatremias at the time of ICU admission are independent risk factors for increased mortality in critically ill patients. ⋯ Our results suggest that both hypo- and hypernatremia present on admission to the ICU are independent risk factors for poor prognosis.
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Intensive care medicine · Feb 2010
ReviewThe Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.
The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. ⋯ The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.
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Intensive care medicine · Feb 2010
Multicenter Study Clinical TrialAn intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study.
To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit (ICU). ⋯ The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients.
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Intensive care medicine · Feb 2010
ReviewIncreased plasma thioredoxin levels in patients with sepsis: positive association with macrophage migration inhibitory factor.
To establish the relationship between plasma levels of thioredoxin (Trx) and macrophage migration inhibitory factor (MIF) in systemic inflammatory stress syndrome (SIRS)/sepsis. ⋯ Plasma levels of Trx, MIF, IL-6, -8, -10 and PCT were raised in patients with SIRS/sepsis. Comparisons between mediators suggest a unique correlation of Trx with MIF. Moreover, Trx and MIF differed from cytokines and PCT in that levels were significantly lower in patients with neutropenia compared with the main SIRS/sepsis group. By contrast, IL-8 and PCT levels were significantly greater in the neutropenic patient group. The link between MIF and Trx highlighted in this study has implications for future investigations into the pathogenesis of SIRS/sepsis.