Journal of critical care
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Journal of critical care · Oct 2018
Randomized Controlled TrialPopulation pharmacokinetics of intravenous paracetamol in critically ill patients with traumatic brain injury.
High-dose paracetamol (6 g/day) is a low-cost intervention that may prevent pyrexia. The purpose of this study was to describe the pharmacokinetics of high-dose intravenous paracetamol, in patients with traumatic brain injury (TBI). ⋯ Due to altered pharmacokinetics, patients experiencing severe TBI may require a higher dose of paracetamol to achieve drug exposure that results in preventing pyrexia.
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Journal of critical care · Oct 2018
Multicenter StudyDiagnosis, management, and prognosis of patients with acute kidney injury in Japanese intensive care units: The JAKID study.
To determine the proportion of diagnosis and outcomes of critically ill patients with acute kidney injury (AKI), and its association with mortality using the complete Kidney Disease Improving Global Outcomes (KDIGO) classification and Sepsis-3 definition. ⋯ AKI accounted for >40% of ICU patients with the KDIGO classification and was associated with increased risk of hospital mortality. Septic AKI was diagnosed in three-fourths of patients with sepsis, while the impact of AKI on hospital mortality among sepsis was not observed.
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Journal of critical care · Oct 2018
ReviewThe use of IgM-enriched immunoglobulin in adult patients with sepsis.
The administration of intravenous immunoglobulins (IVIG) is one of the adjunct therapies investigated and applied to sepsis patients, with the first studies being published nearly four decades ago. Intravenous immunoglobulin preparations have several mechanisms of action e.g. antigen neutralization, Fc-receptor blockade on phagocytic cells, modulation of cytokine responses and modulation of immune cell functions. ⋯ Nevertheless, the results of studies examining its value are contradicting. The purpose of this review is to summarize and present, clearly and thoroughly, the currently available data regarding established and future potential clinical uses of IVIgGM in patients with sepsis.
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Journal of critical care · Oct 2018
Observational StudyUse of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury.
This study aimed to evaluate the safety and efficacy of a regional citrate anticoagulation (RCA) protocol for continuous venovenous hemodialysis (CVVHD) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) setting. ⋯ Filter patency was relatively short and clotting was associated with active cancer disease, genitourinary tumor, lower citrate dose and lower INR.
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Journal of critical care · Oct 2018
Multicenter StudyDetection of invasive pulmonary aspergillosis in critically ill patients by combined use of conventional culture, galactomannan, 1-3-beta-D-glucan and Aspergillus specific nested polymerase chain reaction in a prospective pilot study.
Invasive pulmonary aspergillosis (IPA) is an emerging and life-threatening infectious disease in patients admitted to the intensive care unit (ICU). Most diagnostic studies are conducted in hematological patients and results cannot readily be transferred to ICU patients lacking classical host factors. In a multicenter, prospective clinical trial including 44 ICU patients, hematological (n = 14) and non-hematological patients (n = 30), concurrent serum and bronchoalveolar lavage (BAL) samples were analyzed by conventional culture, galactomannan (GM), 1-3-beta-D-glucan (BDG) as well as an Aspergillus specific nested polymerase chain reaction (PCR). ⋯ Whereas mean GM levels were significantly higher in hematological patients BDG and PCR did not differ between hematological and non-hematological patients. Under present clinical conditions test combinations integrating both BAL and blood samples are advantageous. BDG might best serve as possible indicator for ruling out IPA.