Journal of critical care
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Sepsis is a clinical syndrome characterized by a multisystem response to a microbial pathogenic insult consisting of a mosaic of interconnected biochemical, cellular, and organ-organ interaction networks. A central thread that connects these responses is inflammation that, while attempting to defend the body and prevent further harm, causes further damage through the feed-forward, proinflammatory effects of damage-associated molecular pattern molecules. ⋯ We suggest that attempts to improve clinical outcomes by targeting specific components of this network have been unsuccessful due to the lack of an integrative, predictive, and individualized systems-based approach to define the time-varying, multidimensional state of the patient. We highlight the translational impact of computational modeling and other complex systems approaches as applied to sepsis, including in silico clinical trials, patient-specific models, and complexity-based assessments of physiology.
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Journal of critical care · Jun 2012
Comparative Study Clinical TrialNear-infrared spectroscopy cerebral and somatic (renal) oxygen saturation correlation to continuous venous oxygen saturation via intravenous oximetry catheter.
Near-infrared spectroscopy (NIRS) and continuous central venous oxygen saturation (ScvO(2)) via oximetry catheter are 2 modalities available to estimate adequacy of oxygen delivery in postoperative pediatric cardiac patients. Near-infrared spectroscopy measures regional tissue oxygenation and is routinely used in pediatric cardiac surgery patients. By not requiring an invasive catheter, NIRS has the advantage over mixed venous oxygen saturation (SvO(2)) monitoring. An alternative marker of global tissue oxygenation is central venous oxygen saturation (ScvO(2)). A recently developed pediatric-sized oximetric catheter (PediaSat; Edwards Lifesciences, Irvine, CA, USA) functions as a central venous catheter and provides a continuous ScvO(2) reading, an accepted surrogate to SvO(2). To date, the correlation between NIRS and ScvO(2) has not been quantified. The aim of this study was to examine the strength of the bivariate correlation between NIRS and ScvO(2) measurements. ⋯ In this small cohort of pediatric patients undergoing heart surgery, there was a moderate but statistically significant correlation between the ScvO(2)-catheter and the NIRS-C values. Further studies are required to determine which oxymetric modality of monitoring cardiac output most aids in the postoperative management of these patients.
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Journal of critical care · Jun 2012
Predictors of prolonged vasopressin infusion for the treatment of septic shock.
Prolonged catecholamine use has been linked with poor clinical outcomes, including higher mortality. The objective was to identify characteristics that may be predictive of prolonged arginine vasopressin (AVP) use for 7 days or more in patients with septic shock. ⋯ Patients with preexisting PVD and AKI and those experiencing a new ICU arrhythmia on AVP may be more likely to remain on AVP for 7 or more days.
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Journal of critical care · Jun 2012
Clinical TrialImpact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study.
The purpose of this study was to determine the impact of high-flow nasal cannula oxygen (HFNC) on patients with acute respiratory failure (ARF) in comparison with conventional oxygen therapy. ⋯ Use of HFNC in patients with persistent ARF was associated with significant and sustained improvement of both clinical and biologic parameters.
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Journal of critical care · Jun 2012
Pleural antigen assay in the diagnosis of pediatric pneumococcal empyema.
The purpose of the study was to assess the diagnostic value of rapid pneumococcal antigen detection (PAD) in pleural fluid samples of children with empyema. ⋯ Pneumococcal antigen detection in pleural fluid specimens from children provides a rapid, simple, sensitive, and reliable method of diagnosis for pneumococcal empyema at bedside.