Journal of critical care
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Journal of critical care · Feb 2016
Branched DNA-based Alu quantitative assay for cell-free plasma DNA levels in patients with sepsis or systemic inflammatory response syndrome.
Cell-free circulating DNA (cf-DNA) can be detected by various of laboratory techniques. We described a branched DNA-based Alu assay for measuring cf-DNA in septic patients. Compared to healthy controls and systemic inflammatory response syndrome (SIRS) patients, serum cf-DNA levels were significantly higher in septic patients (1426.54 ± 863.79 vs 692.02 ± 703.06 and 69.66 ± 24.66 ng/mL). ⋯ Branched DNA-based Alu assays are feasible and useful to quantify serum cf-DNA levels. Increased cf-DNA levels in septic patients might complement C-reactive protein and procalcitonin in a multiple marker format. Cell-free circulating DNA might be a new marker in discrimination of sepsis and SIRS.
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To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures. ⋯ Low Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures, but not Vt, was significantly associated with poorer outcomes after lung transplantation.
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Journal of critical care · Feb 2016
Observational StudyRisk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department.
The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation. ⋯ We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention.
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Journal of critical care · Feb 2016
Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.
Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. ⋯ Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies.
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Journal of critical care · Feb 2016
Superiority of transcutaneous CO2 over end-tidal CO2 measurement for monitoring respiratory failure in nonintubated patients: A pilot study.
Arterial blood gas measurement is frequently performed in critically ill patients to diagnose and monitor acute respiratory failure. At a given metabolic rate, carbon dioxide partial pressure (PaCO2) is entirely determined by CO2 elimination through ventilation. Transcutaneous partial pressure of carbon dioxide (PtcCO2) monitoring permits a noninvasive and continuous estimation of arterial CO2 tension (PaCO2). The accuracy of PtcCO2, however, has not been well studied. To assess the accuracy of different CO2 monitoring methods, we compared PtcCO2 and end-tidal CO2 concentration (EtCO2) to PaCO2 measurements in nonintubated intensive care unit (ICU) patients with acute respiratory failure. ⋯ We found large differences between EtCO2 and Paco2 in spontaneously breathing nonintubated ICU patients admitted for acute respiratory failure. Our study argues against the use of EtCO2 monitoring in such patients but raises the possibility that PtcCO2 measurement may provide reasonable estimates of PaCO2.