Journal of critical care
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Journal of critical care · Dec 2017
Observational StudyQuick sequential organ failure assessment compared to systemic inflammatory response syndrome for predicting sepsis in emergency department.
It is unclear whether quick sequential (sepsis-related) organ failure assessment (qSOFA) also has prognostic value for organ failure in patients with a suspected infection. The aim of this study was to determine whether qSOFA has prognostic value when compared to systemic inflammatory response syndrome (SIRS) in predicting organ failure in patients with a suspected infection in an emergency department (ED). ⋯ qSOFA has a superior ability compared to SIRS in predicting the occurrence of organ failure in patients with a suspected infection. However, given the low sensitivity of qSOFA, further confirmatory tests for organ failure are needed.
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Journal of critical care · Dec 2017
Hyperglycemia-induced hyponatremia: Reevaluation of the Na(+) correction factor.
This study addresses the clinically important relationship between the decreases in plasma Na+ and the increases in plasma glucose concentrations seen in diabetes and other hyperglycemic syndromes. This plasma 'Na+ correction factor', is generally accepted as 1.6mM Na+ per 100mg% glucose (0.29mM/mM in SI units) assuming osmotic equilibrium, although much larger numbers have been measured in experiments on normal humans. ⋯ The findings, based on osmotic grounds, were that the factor 1) was significantly <1.6, approaching 1 in some cases, 2) depended upon the anthropometry of the subject; it was inversely proportional to the ratio of extracellular to total body water, which increases with higher fat content and 3) was approximately linear up to glucose concentrations of about 800mg%, but decreased up to 10% for higher glucose concentrations. To explain the experimental data, a hypothesis of Na+ sequestration in cells was incorporated in the model, resulting in close prediction of measured transient Na+ changes.
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Journal of critical care · Dec 2017
Concomitant vasopressin and hydrocortisone therapy on short-term hemodynamic effects and vasopressor requirements in refractory septic shock.
The objective of this study was to evaluate the short-term hemodynamic effects as well as vasopressor requirements with concomitant vasopressin (AVP) and hydrocortisone (HCT) compared to either agent alone in refractory septic shock. ⋯ Concomitant AVP and HCT was associated with an immediate, additive catecholamine-sparing effect over either agent alone in patients with refractory septic shock.