Journal of critical care
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Journal of critical care · Oct 2013
Randomized Controlled TrialEffect of perioperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during living donor liver transplantation.
End-stage liver disease is associated with marked hemodynamic disturbances that are further aggravated during liver transplantation. Terlipressin has been shown to be effective in the management of sepsis-induced hypotension and hepatorenal syndrome and recently has been tried as infusion during liver transplantation. This study assessed the effect of intraoperative and postoperative terlipressin infusion on systemic, hepatic, and renal hemodynamics during adult living donor liver transplantation. ⋯ Terlipressin infusion significantly decreased HARI, RARI, and portal vein flow and improved low systemic vascular resistance and mean arterial pressure. It helped to reduce intraoperative vasoactive support and might improve postoperative renal function.
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Journal of critical care · Oct 2013
ReviewHow to select an antifungal agent in critically ill patients.
Fungal infections are common in critically ill patients and are associated with increased morbidity and mortality. Candida spp are the most commonly isolated fungal pathogens. The last 2 decades have seen an increased incidence of fungal infections in critical illness and the emergence of new pathogenic fungal species and also the development of more effective (better bioavailability) and safer (less toxicity, fewer drug interactions) drugs. ⋯ The antifungal agents that are most frequently used in the intensive care unit are the first- and second-generation azoles and the echinocandins; amphotericin B derivatives (mainly the liposomal agents) are less widely used because of adverse effects. The choice of antifungal agent in critically ill patients will depend on the aim of therapy (prophylaxis, pre-emptive, empiric, definitive), as well as on local epidemiology and specific properties of the drug (antifungal spectrum, efficacy, toxicity, pharmacokinetic/pharmacodynamic properties, cost). In this article we will review all these aspects and propose an algorithm to guide selection of antifungal agents in critically ill patients.
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Journal of critical care · Oct 2013
Comparative StudyComparison of predictive powers of S100B and cell-free plasma DNA values in intensive care unit patients with intracranial hemorrhage.
To investigate predictive powers of S100B and cell-free DNA (cfDNA) levels in patients in the intensive care unit (ICU) who have with intracranial hemorrhage (ICH) for prognosis. ⋯ Both S100B and cfDNA values can be used as markers to predict the prognosis of ICU patients with ICH. However, S100B is more powerful for predicting the prognosis.
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Journal of critical care · Oct 2013
Use of venovenous extracorporeal membrane oxygenation in central airway obstruction to facilitate interventions leading to definitive airway security.
Extracorporeal membrane oxygenation (ECMO) is useful for providing hypoxic patients with ventilatory support, but its usefulness in the management of patients with central airway obstruction has rarely been reported. Nineteen cases in one center where venovenous (VV) ECMO was used to support patients with severe central airway obstruction while they underwent lifesaving interventions are reported here. ⋯ Venovenous ECMO may be useful in patients with central airway obstruction because it provides short-term airway security while lifesaving procedures are being performed.