Journal of critical care
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Journal of critical care · Oct 2012
Integrating lung ultrasound in the hemodynamic evaluation of acute circulatory failure (the fluid administration limited by lung sonography protocol).
In circulatory failure, fluid administration limited by lung sonography protocol uses lung ultrasound artifacts and makes sequential diagnosis of obstructive, cardiogenic, hypovolemic, and septic shock. Lung ultrasound is used along with simple cardiac and vena cava analysis. Whenever echocardiography cannot be performed, fluid administration limited by lung sonography protocol is favored because of its simplicity and could prove contributive. ⋯ Whenever noninvasive hemodynamic measures are inconclusive, in a deteriorating patient, a pulmonary artery catheter may be placed. Ultrasound is not a therapy but a guide for treatment, and physicians should aim to treat underlying pathologies. Despite its limitations, general chest ultrasound (lung and cardiac ultrasound) is a powerful diagnostic and monitoring tool reflecting an era of genuine "visual" medicine.
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Journal of critical care · Oct 2012
The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability.
Measurement error and transient variability affect vital signs. These issues are inconsistently considered in published reports and clinical practice. We investigated the association between major hemorrhagic injury and vital signs, successively applying analytic techniques that excluded unreliable measurements, reduced transient variation, and then controlled for ambiguity in individual vital signs through multivariate analysis. ⋯ Techniques to reduce variability in vital sign data can lead to significantly improved diagnostic performance. Failure to consider such variability could significantly reduce clinical effectiveness or confound research investigations.
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Journal of critical care · Oct 2012
The Sequential Organ Failure Assessment score and copeptin for predicting survival in ventilator-associated pneumonia.
Ventilator-associated pneumonia remains the most common nosocomial infection in the critically ill and contributes to significant morbidity. Eventual decisions regarding withdrawal or maximal therapy are demanding and rely on physicians' experience. Additional objective tools for risk assessment may improve medical judgement. Copeptin, reflecting vasopressin release, as well as the Sequential Organ Failure Assessment (SOFA) score, reflecting the individual degree of organ dysfunction, might qualify for survival prediction in ventilator-associated pneumonia. We investigated the predictive value of the SOFA score and copeptin in ventilator-associated pneumonia. ⋯ The predictive value of serial-measured SOFA significantly exceeds those of single SOFA and copeptin measurements. Serial SOFA scores accurately predict outcome in ventilator-associated pneumonia.
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Journal of critical care · Oct 2012
Hypothermia attenuates the severity of oxidative stress development in asphyxiated newborns.
This retrospective case-control study aimed to examine the development of oxidative stress in asphyxiated infants delivered at more than 37 weeks of gestation. ⋯ This study demonstrated that hypothermia attenuated the development of systemic oxidative stress in asphyxiated newborns.
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Journal of critical care · Oct 2012
Plasma C-reactive protein levels are associated with mortality in elderly with acute lung injury.
The plasma C-reactive protein (CRP) level is considered to be a predictor of severity in both hospital- and community-acquired pneumonias, whereas recent reports have shown that higher CRP levels lead to better outcomes in patients with acute lung injury (ALI). To explain this discrepancy, we evaluated the relationship among plasma CRP levels, etiology, affectors of CRP production, and mortality in patients with ALI. ⋯ The plasma CRP level may be a predictor of mortality in elderly patients with ALI.