Journal of intensive care medicine
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J Intensive Care Med · Jul 2007
ReviewLumbar puncture and brain herniation in acute bacterial meningitis: a review.
There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy. Cerebral herniation occurs in about 5% of patients with ABM, accounting for about 30% of the mortality. ⋯ Some of these clinical signs to be considered are deteriorating level of consciousness (particularly to a Glasgow Coma Scale of
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Dysfunction of the vascular endothelium (ET) causes an increase in serum ET-1 concentration, as observed in septic patients. It was assumed that in this patient population the ET-1 level correlates with the degree of sepsis severity, including the level of organ dysfunction and, in particular, the level of circulatory dysfunction. The aim of the present study was to assess the relationship between levels of ET-1 and levels of N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT), and C-reactive protein (CRP), as well as the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients. ⋯ Correlation between the ET-1 levels and SOFA score was .470 (P < .001). Six patients (30%) died during the observation period of 28 days. ET-1 levels correlate with levels of NT-proBNP, PCT, and CRP, as well as the SOFA score in septic patients.
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J Intensive Care Med · Jul 2007
ReviewComplications of emergency tracheal intubation: immediate airway-related consequences: part II.
Airway management in the stable, elective operating room patient is typically exceptionally safe. Conversely, the acute deterioration of an intensive care unit or floor patient being rescued by a clinician unfamiliar with the patient's past and current history combined with an incomplete physical examination places the critically ill patient in a precarious, potentially life-threatening position. ⋯ Consequences of airway management should be openly discussed as a first step toward improving airway safety. This is the second of 2 reviews, "Complications of Emergency Tracheal Intubation," and focuses on the immediate airway-related consequences during emergency tracheal intubation in the remote location.