Journal of critical care
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Journal of critical care · Oct 2012
Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock.
No prognostic markers of myocardial recovery in patients with refractory cardiogenic shock requiring circulatory support are known, but early identification of patients who will not recover might provide an opportunity to change the treatment strategy to improve outcome. Because N-terminal fragment of the B-type natriuretic peptide, troponin Ic, midregional fragment of the proatrial natriuretic peptide, proadrenomedullin, and copeptin are prognostic markers in patients with cardiac failure, we hypothesized that, among patients with refractory cardiogenic shock of potentially reversible cause supported with extracorporeal membrane oxygenation (ECMO), the kinetics of these markers might help identify patients who would recover. ⋯ In patients with refractory cardiogenic shock of potentially reversible cause receiving ECMO support, early measurements of cardiac biomarkers are not useful for identifying those who would recover.
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Journal of critical care · Oct 2012
Association of platelet counts decline and mortality in severely burnt patients.
Although the dramatic fluctuation of platelet counts (PCs) has always been observed in severely burnt patients, the underlying relationship between the decline of PCs and mortality has never been well defined. In this study, we evaluated the prognostic implications of PC decline in severely burnt patients. We performed a 3-year retrospective chart of adult patients with a burn index of 50 or greater admitted to 2 burn centers. ⋯ Furthermore, an optimal cutoff of PPC during the first 3 days, which discriminated survivors with nonsurvivors, was 65.53% using the maximum Youden index (0.4853). Although the sensitivity and specificity of PPC during the first 3 days were not as high as the Acute Physiology And Chronic Health Evaluation II score in the present study, Kaplan-Meier estimation and multiple logistic regression models both indicated that a PPC of 65% or greater during the first 3 days was significantly associated with 30-day death (odds ratio, 1.054; 95% confidence interval, 1.006-1.104; P = .028). In summary, an initial slump of PCs, especially a PPC of 65% or greater during the first 3 days, provides prognostic significance for 30-day mortality in severely burnt patients.
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Journal of critical care · Oct 2012
Clinical TrialA new parameter for the diagnosis of hemorrhagic shock: jugular index.
The purpose of this study is to investigate whether there are any significant changes in the diameter and the area of the internal jugular vein (IJV) during the hemorrhagic shock. ⋯ We believe that measurement of the IJV and the jugular index is a reliable indicator of class 1 hemorrhagic shock. It may be used as a part of focused abdominal sonography for trauma in clinical practice.
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Journal of critical care · Oct 2012
Discordance between microcirculatory alterations and arterial pressure in patients with hemodynamic instability.
Recent studies reported that microcirculatory blood flow alterations occur in patients with circulatory shock independent of arterial pressure but typically lack baseline microcirculatory data before the insult and after recovery. We selected cardiopulmonary bypass (CPB) patients with expected and rapidly reversible hemodynamic instability to test the hypothesis that microcirculatory alterations can occur independent of mean arterial pressure (MAP). ⋯ In this cohort of patients with hemodynamic instability, we observed discordance between microcirculatory blood flow and arterial pressure. These data support the concept that microcirculatory blood flow indices can yield physiologic information distinct from macrocirculatory hemodynamic parameters.
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Journal of critical care · Oct 2012
Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage.
Reducing the incidence of hospital-acquired pneumonia (PNU) is important but depends on accurate assessment. We sought to determine the interrater reliability of diagnosis of PNU and its impact on resource utilization and functional outcomes in a high-risk population. ⋯ Pneumonia had poor interrater reliability despite highly trained reviewers and validated criteria. Although the clinical assessment of PNU is difficult, it was associated with greater resource use and worse outcomes. Diagnosis of clinical PNU may be suboptimal for measuring quality of intensive care.