Journal of intensive care medicine
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J Intensive Care Med · Jan 2011
Multicenter StudyReview of a large clinical series: Predicting death for patients with abdominal septic shock.
This paper reports the result of the MEDAN project that analyzes a multicenter septic shock patient data collection. The mortality prognosis based on 4 scores that are often used is compared with the prognosis of a trained neural network. We built an alarm system using the network classification results. ⋯ However, when the trained network computes a score value below the threshold during the ICU stay, there is a high probability that the patient will die within 3 days. The trained neural network obtains the same outcome prediction performance as the best score, the SOFA score, using narrower confidence intervals and considering three variables only: systolic blood pressure, diastolic blood pressure and the number of thrombocytes. We conclude that the currently best available score for abdominal septic shock may be replaced by the output of a trained neural network with only 3 input variables.
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J Intensive Care Med · Jan 2011
ReviewA review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients.
Extracorporeal membrane oxygenation (ECMO) comprises a commonly used method of extracorporeal life support. It has proven efficacy and is an accepted modality of care for isolated respiratory or cardiopulmonary failure in neonatal and pediatric populations. ⋯ As such, all intensivists should be familiar with the evidence-base and principles of ECMO in adult population. The purpose of this article is to review the evidence and to describe the fundamental steps in initiating, adjusting, troubleshooting, and terminating ECMO so as to familiarize the intensivist with this modality.
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J Intensive Care Med · Nov 2010
Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia.
Carbapenem-resistant (CR) Acinetobacter baumannii is an important pathogen in ventilator-associated pneumonia (VAP), but therapeutic options are limited. We describe the clinical outcomes of the largest case series of CR-Acinetobacter VAP reported to date. ⋯ Our results demonstrated that CR-Acinetobacter VAP can be effectively treated with second-line agents. However, colistin-related nephrotoxicity was much higher than recently reported and decreased susceptibility to tigecycline emerged on therapy demonstrating the limitations of alternative regimens.
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Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. ⋯ Clinical application includes the treatment of bacteremia, endocarditis, health-care and nosocomial pneumonias, intra-abdominal infections, and others. Nephrotoxicity and ototoxicity are potential risks of aminoglycoside therapy that may be minimized with serum monitoring and short courses of therapy.
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J Intensive Care Med · Nov 2010
Preliminary experience with clevidipine in the pediatric population.
Clevidipine is a third-generation calcium channel antagonist of the dihydropyridine group. Like nicardipine, its primary physiologic effect is vasodilation, primarily of the arterial system with limited effects on capacitance vessels. Unlike other direct-acting vasodilators, it has an ultrashort half-life due to its metabolism by nonspecific blood and tissue esterases. ⋯ The clevidipine infusion was started at 0.5 to 1 μg/kg per minute and titrated up to 3.5 μg/kg per minute as needed. No excessive hypotension was noted; however, intermittent doses of metoprolol were required to control reflex tachycardia in 2 of the 10 patients and an elevated triglyceride level was noted in 1 patient. Our preliminary experience demonstrates the efficacy of clevidipine for blood pressure control during the perioperative period.