Journal of critical care
-
Journal of critical care · Dec 2014
ReviewMitochondrial DNA neutrophil extracellular traps are formed after trauma and subsequent surgery.
Neutrophil extracellular traps (NETs) have not been demonstrated after trauma and subsequent surgery. Neutrophil extracellular traps are formed from pure mitochondrial DNA (mtDNA) under certain conditions, which is potently proinflammatory. We hypothesized that injury and orthopedic trauma surgery would induce NET production with mtDNA as a structural component. ⋯ Neutrophil extracellular traps formed after major trauma and subsequent surgery contain mtDNA and represent a novel marker of heightened innate immune activation. They could be considered when timing surgery after trauma to prevent systemic NET-induced inflammatory complications.
-
Journal of critical care · Dec 2014
Clinical TrialPulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial.
The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery. ⋯ Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.
-
Journal of critical care · Dec 2014
The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters.
We aimed to evaluate the effects of transjugular intrahepatic portosystemic stent shunt (TIPS) on systemic cardiocirculatory parameters in patients treated with TIPS for portal hypertension-associated complications. ⋯ Transjugular intrahepatic portosystemic stent shunt placement is associated with an increase in central venous pressure and an improvement of global blood flow (cardiac index and stroke volume index) in patients with portal hypertension.
-
Journal of critical care · Dec 2014
EditorialAnalysis of the reports of high-level commissions that have comprehensively reviewed US public policy on brain death.
The notion of brain death from its inception has not been uniformly understood with many grisly conceptions of it as it pertains to reliability and to organ donation. Accordingly, the aforementioned recitation of statutes and commission reports has served a useful societal role in addressing controversies and misconceptions while promulgating unifying foundational concepts and guidance in practical translation to clinical practice. ⋯ The second is through established procedures to reliably determine the presence of total brain death with the presence of a comatose state which is irreversible. Another common thread through the ethically focused reports has been recognition that organ donation and death are temporally and geographically associated but there is emphasis that the processes of determination of death(by somatic or cerebral criteria) must be logically, ethically, and procedurally separate from the procedures for performing organ harvesting and transplantation.
-
Journal of critical care · Dec 2014
Admission high serum sodium is not associated with increased intensive care unit mortality risk in respiratory patients.
Because increased serum osmolarity may be lung protective, we hypothesized that increased mortality associated with increased serum sodium would be ameliorated in critically ill patients with an acute respiratory diagnosis. ⋯ High admission serum sodium is associated with increased odds for ICU death, except in respiratory patients.