Journal of critical care
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Journal of critical care · Oct 2012
Lower serum endocan levels are associated with the development of acute lung injury after major trauma.
Endocan is a proteoglycan expressed by endothelial cells in the lung that may inhibit leukocyte recruitment and thus prevent the development of acute lung injury (ALI). We tested the association of serum endocan levels with subsequent development of ALI after major trauma. ⋯ Lower levels of serum endocan on admission are associated with subsequent development of ALI in trauma patients. These observations may be explained by endocan-mediated blockade of leukocyte recruitment in the lung.
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Journal of critical care · Oct 2012
Clinical TrialAdrenal insufficiency in cardiothoracic patients: an evaluation of the corticotrophin stimulation test and other diagnostic methods.
The purposes of the study were to determine the incidence of adrenal insufficiency (AI) using several published techniques, compare the response rates using a low-dose (LD) corticotropin (ACTH) stimulation test vs a standard dose (SD), and identify the technique that is most closely related to vasopressor use. ⋯ The incidence of AI will vary greatly based on technique used for diagnosis. The SD-ACTH stimulation test should be used to determine AI in open heart patients postoperatively because of the close association with vasopressor usage.
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Journal of critical care · Oct 2012
Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock.
No prognostic markers of myocardial recovery in patients with refractory cardiogenic shock requiring circulatory support are known, but early identification of patients who will not recover might provide an opportunity to change the treatment strategy to improve outcome. Because N-terminal fragment of the B-type natriuretic peptide, troponin Ic, midregional fragment of the proatrial natriuretic peptide, proadrenomedullin, and copeptin are prognostic markers in patients with cardiac failure, we hypothesized that, among patients with refractory cardiogenic shock of potentially reversible cause supported with extracorporeal membrane oxygenation (ECMO), the kinetics of these markers might help identify patients who would recover. ⋯ In patients with refractory cardiogenic shock of potentially reversible cause receiving ECMO support, early measurements of cardiac biomarkers are not useful for identifying those who would recover.
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Journal of critical care · Oct 2012
Association of platelet counts decline and mortality in severely burnt patients.
Although the dramatic fluctuation of platelet counts (PCs) has always been observed in severely burnt patients, the underlying relationship between the decline of PCs and mortality has never been well defined. In this study, we evaluated the prognostic implications of PC decline in severely burnt patients. We performed a 3-year retrospective chart of adult patients with a burn index of 50 or greater admitted to 2 burn centers. ⋯ Furthermore, an optimal cutoff of PPC during the first 3 days, which discriminated survivors with nonsurvivors, was 65.53% using the maximum Youden index (0.4853). Although the sensitivity and specificity of PPC during the first 3 days were not as high as the Acute Physiology And Chronic Health Evaluation II score in the present study, Kaplan-Meier estimation and multiple logistic regression models both indicated that a PPC of 65% or greater during the first 3 days was significantly associated with 30-day death (odds ratio, 1.054; 95% confidence interval, 1.006-1.104; P = .028). In summary, an initial slump of PCs, especially a PPC of 65% or greater during the first 3 days, provides prognostic significance for 30-day mortality in severely burnt patients.
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Journal of critical care · Oct 2012
Clinical TrialA new parameter for the diagnosis of hemorrhagic shock: jugular index.
The purpose of this study is to investigate whether there are any significant changes in the diameter and the area of the internal jugular vein (IJV) during the hemorrhagic shock. ⋯ We believe that measurement of the IJV and the jugular index is a reliable indicator of class 1 hemorrhagic shock. It may be used as a part of focused abdominal sonography for trauma in clinical practice.