Journal of critical care
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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
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.
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Journal of critical care · Feb 2014
The outcome of cancer patients with acute respiratory distress syndrome.
The objective of the study is to determine the 28-day mortality of critically ill cancer patients with acute respiratory distress syndrome (ARDS). ⋯ Cancer patients with ARDS have a significantly higher risk of death compared with those without cancer. The increased risk appeared to be mediated by increased severity of illness at presentation, as well as by age.
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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
Racial differences in withdrawal of mechanical ventilation do not alter mortality in neurologically injured patients.
Racial differences in withdrawal of mechanical ventilation (WMV) have been demonstrated among patients with severe neurologic injuries. We ascertained whether such differences might be accounted for by imbalances in socioeconomic status or disease severity, and whether such racial differences impact hospital mortality or result in greater discharge to long-term care facilities. ⋯ Surrogates of nonwhite neurologically injured patients chose WMV less often even after correcting for socioeconomic status and other confounders. This difference in end-of-life decision making does not appear to alter hospital mortality but may result in more survivors left in a disabled state.