Journal of critical care
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Journal of critical care · Aug 2014
EditorialBiophilosophical basis for identifying the death of a person.
The capacity for consciousness and self-awareness is uniquely synonymous with human life and personhood, and its absence is necessary and sufficient to identify that death has occurred. The presence of these functions is uniquely synonymous with human life. Ongoing organ function, response to infection, growth, wound healing, or the ability to sustain an unborn fetus do not alone constitute the unique experience of life and personhood. ⋯ Progressive hypoxia that is seen in many patients after withdrawal of advanced physiologic support leads to apnea and then circulatory arrest. The outward sign of apnea that is then followed by circulatory arrest is the basis for inferring that irreversible loss of capacity for consciousness and self-awareness has occurred and that death can be identified has having occurred. The capacity for consciousness and self-awareness is the only irreplaceable emergent phenomenon—arising from physiologic function of the brain—that is necessary and sufficient to define the life of a person.
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Journal of critical care · Aug 2014
ReviewMeasurement of the glucocorticoid receptor: Relevance to the diagnosis of critical illness-related corticosteroid insufficiency in children.
Diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in children continues to remain difficult and controversial in that no consensus for either exists among pediatric critical care physicians. Critical illness-related corticosteroid insufficiency is defined as a corticosteroid response that is inadequate for the severity of the illness experienced by the patient. ⋯ This article details the role of the GR during critical illness with a focus upon the measurement of the GR, as a potentially important means by which to clinically assess the level of corticosteroid tissue-resistant in patients suspected of CIRCI. Measurement of the GR may be particularly useful as a means by which to determine the judicious administration of steroids, maximizing their therapeutic potential, whereas minimizing the morbidity that can be associated with their use.
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Journal of critical care · Aug 2014
Renal outcome after vancomycin treatment and renal replacement therapy in patients with severe sepsis and septic shock: A retrospective study.
Acute kidney injury during systemic infections is common; however, renal outcome is poorly investigated. The increase of multiresistant pathogens leads to the use of potential nephrotoxic antibiotics as vancomycin. We investigated the impact of vancomycin and renal replacement therapy (RRT) for renal recovery during sepsis. ⋯ Estimated GFR at ICU admission predicts renal outcome, whereas the use of vancomycin increases the probability of a prolonged need for RRT at discharge from ICU. The use of alternative antibiotics for certain patients, indicated by eGFR at admission, might be considered.
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Journal of critical care · Aug 2014
Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia.
Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP). ⋯ The mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions.
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The objective of this study was to determine the effect of early vs late vasopressin therapy on catecholamine dose and duration. ⋯ Early initiation of vasopressin therapy in adult critically ill patients with septic shock was associated with no difference in total catecholamine requirements but decreased incidence of new onset arrhythmias.