Journal of critical care
-
The role of microparticles (MPs) in the pathogenesis of sepsis is not completely elucidated. We aimed to assess changes in the number of MPs during severe sepsis to follow the effect of sepsis-related organ failures, particularly renal impairment, an independent mortality factor of sepsis. ⋯ The increased numbers of platelet-derived MPs in severe septic patients emphasize the possible contribution of the hemostasis system in the development of sepsis-related renal impairments.
-
Journal of critical care · Apr 2013
Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients.
The purpose of this study was to investigate the impact of large-volume thoracentesis (>1000 mL) on transpulmonary thermodilution (TPTD)-derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI). ⋯ Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.
-
Colistin is a venerable drug that has found renewed interest because of multidrug resistance (MDR) and the shortfall of effective antibiotics. We present a synthesis of publication trends on MDR infection, colistin, and its adverse events, as a measure of the medical-academic community's interest, to inform current redevelopment strategies. ⋯ Two current trends (period C) were identified. Optimization of the current formulation may have been influenced by period B. Current research efforts within this trend include pharmacokinetic/pharmacodynamic analysis, purification, formulation, and resistance surveillance. The second trend involved colistin's redevelopment by tailored chemical reengineering to produce novel and patentable chemical entities, with an interdisciplinary approach emphasis. It is hoped that an analysis of the interplay between historical trends and current redevelopment strategies of this colistin case study may highlight strategies to stoke the drying antibiotic pipeline.
-
Journal of critical care · Apr 2013
Use of a protocolized approach to the management of sepsis can improve time to first dose of antibiotics.
The Surviving Sepsis Guidelines established recommendations for early recognition and rapid treatment of patients with sepsis. Recognizing systemic difficulties that delayed the application of early goal-directed therapy, the Emergency Department and Critical Care leadership instituted a sepsis protocol to identify patients with sepsis and expedite antibiotic delivery. We aimed to determine if the sepsis protocol improved the time to first dose of antibiotics in patients diagnosed with sepsis. ⋯ Initiation of a sepsis protocol, which emphasizes early goal-directed therapy, can improve time to administration of first dose of antibiotics.
-
Journal of critical care · Apr 2013
Determinants of renal function at hospital discharge of patients treated with renal replacement therapy in the intensive care unit.
Identification of risk factors for impaired renal function at hospital discharge in critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT). ⋯ Elderly and patients with pre-existing CKD are at a high risk for modest to severely impaired renal function at hospital discharge after AKI requiring RRT.