Journal of critical care
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Journal of critical care · Dec 2011
Discrepancies in the RIFLE classification are due to the method used to assess the level of derangement of kidney function.
We hypothesized that RIFLE based on creatinine clearance (CrCl) is superior to that based on serum creatinine (sCr) or Cockroft-Gault (C-G) because it is an earlier marker of kidney dysfunction. ⋯ RIFLE classification using sCr or C-G at the third day of admission predicts outcome less accurately than with the use of CrCl. Because of the delay in the rise of sCr after a sudden glomerular filtration rate decrease, RIFLE based in CrCl may represent an advantage in terms of precocity.
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Journal of critical care · Dec 2011
Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients.
Transfer of critically ill patients from outside emergency department has the potential for delaying the admission to the intensive care unit. We sought to determine the effect of outside emergency department transfer on hospital outcomes in critically ill patients with stroke. ⋯ These data suggest that in critically ill patients with stroke, transfer from outside emergency department is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect.
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Journal of critical care · Dec 2011
Dynamic changes of matrix metalloproteinases and their tissue inhibitors in severe sepsis.
Little is known about the dynamic changes of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in sepsis. Our aim was therefore to investigate the time course of MMPs and their inhibitors in patients experiencing severe sepsis. ⋯ Our research is the first follow-up study dealing with MMPs, TIMPs, and their ratios in severe sepsis. Our results indicate that MMPs and TIMPs may play a crucial role in severe sepsis, especially TIMP-1, MMP-9, and possibly TIMP-2, after an extensive study.
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Journal of critical care · Dec 2011
Acute kidney injury on ventilator initiation day independently predicts prolonged mechanical ventilation in intensive care unit patients.
The purpose of this study is to identify the predictors for prolonged mechanical ventilation (PMV) of more than 21 days among intensive care unit (ICU) patients. ⋯ Acute kidney injury on MV initiation day is an independent risk factor for PMV of more than 21 days, which may be helpful for clinicians to refine their management of these ICU patients early.
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Journal of critical care · Dec 2011
Elevated plasma matrix metalloproteinases and their tissue inhibitors in patients with severe sepsis.
Matrix metalloproteinases (MMPs) are essential for tissue remodeling. Our objectives were to determine (1) the concentrations of MMPs and their tissue inhibitors (TIMPs) in plasma obtained from patients with severe sepsis, (2) to correlate changes in MMP and TIMP levels with disease severity, and (3) to investigate recombinant activated protein C (rAPC) actions on plasma MMP2, 9 activities from severe sepsis patients. ⋯ Most plasma MMPs and TIMPS were elevated in patients with severe sepsis, but only a limited subset of MMPs (7, 9) negatively correlated with disease severity. Recombinant activated protein C does not appear to directly alter MMP2, 9 activities.