Journal of critical care
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Journal of critical care · Feb 2014
ReviewVasoplegia in septic shock: Do we really fight the right enemy?
Vasoplegia is a key factor for the death of patients with septic shock in intensive care unit owing to persistent and irreversible hypotension. Impairment of vascular reactivity has been attributed to a combination of endothelial injury, arginine-vasopressin system dysfunction, release of other vasodilatory inflammatory mediators, and muscle hyperpolarizaton. ⋯ However, inhibition of nitric oxide synthase only partially restores the endotoxin-induced vascular hyporeactivity. The aim of this review is to discuss in detail the recent suggested alternative mechanisms of vasoplegia and to briefly outline the current therapeutic strategies and the novel therapeutic options based on those mechanisms.
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Journal of critical care · Feb 2014
Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation.
The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma. ⋯ Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.
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Journal of critical care · Feb 2014
The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis.
Thiamine functions as an important cofactor in aerobic metabolism and thiamine deficiency can contribute to lactic acidosis. Although increased rates of thiamine deficiency have been described in diabetic outpatients, this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA). In the present study, we hypothesize that thiamine deficiency is associated with elevated lactate in patients with DKA. ⋯ Patients with DKA had a high prevalence of thiamine deficiency. Thiamine levels were inversely related to lactate levels among patients with DKA. A study of thiamine supplementation in DKA is warranted.
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Journal of critical care · Feb 2014
Multicenter StudyAre written advance directives helpful to guide end-of-life therapy in the intensive care unit? A retrospective matched-cohort study.
The purpose of the study was to determine whether treatment preferences in patients' advance directives (ADs) are associated with life-supporting treatments received during end-of-life care in the intensive care unit (ICU). ⋯ Patients with ADs are less likely to receive cardiopulmonary resuscitation but otherwise receive similar life-sustaining treatments compared to matched patients without ADs. More research is needed to explore reasons for potential noncompliance with patient preferences.
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Journal of critical care · Feb 2014
ReviewEchocardiography in the use of noninvasive hemodynamic monitoring.
Invasive pulmonary artery catheter measurements are the standard method for assessment of hemodynamic evaluation at the present time. However, this invasive approach is associated with an increase in patient morbidity and without evidence of a reduction in mortality. ⋯ Most of these measurements are easily obtained and provide a safe alternative to invasive hemodynamic assessment. As Doppler echocardiography is able to provide additional valuable information, such as cardiac systolic and diastolic function, and the presence of pericardial and pleural effusions, which can play a significant role in the patients' hemodynamic status, using this noninvasive modality in the daily practice for hemodynamic assessment can prove an alternative to invasive measures in selected patients as well as a complementary tool for those still in need of invasive monitoring.