Journal of critical care
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Journal of critical care · Jun 2012
Response to the high-dose corticotrophin stimulation test depends on plasma adrenocotropin hormone levels in septic shock.
The use of the high-dose corticotrophin stimulation test (HDCST) as a guide to use low-dose steroid therapy in septic shock is controversial. The adrenocotropin hormone (ACTH) constitutes the immediate stimuli to produce cortisol. We evaluated the correlation of the response to the HDCST with plasma ACTH levels in patients with septic shock. ⋯ Patients with septic shock with higher plasma ACTH values presented a subnormal response to the HDCST. The number of patients who failed to the HDCST was higher as plasma ACTH increased.
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Journal of critical care · Jun 2012
Clinical implications of right ventricular dysfunction in patients with acute symptomatic pulmonary embolism: short- and long-term clinical outcomes.
Right ventricular dysfunction (RVD) has been found to have a negative impact on the short-term prognosis of patients with pulmonary embolism (PE). However, the long-term prognosis of such patients has not been well defined. We evaluated the effect of RVD on short- and long-term mortality in Korean patients with PE. ⋯ Right ventricular dysfunction without hemodynamic instability was not associated with short- or long-term mortality of patients with PE.
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Journal of critical care · Jun 2012
Comparative StudyA comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients.
Multiple equations exist for predicting resting energy expenditure (REE). The accuracy of these for estimating energy requirements of critically ill patients is not clear, especially for obese patients. We sought to compare REE, calculated with published formulas, with measured REE in a cohort of mechanically ventilated subjects. ⋯ None of these equations accurately estimated measured REE in this group of mechanically ventilated patients, most underestimating energy needs. Development of improved predictive equations for adequate assessment of energy needs is needed.
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Journal of critical care · Jun 2012
Controlled Clinical TrialA pilot clinical trial to evaluate a novel time-to-positivity assay to measure the effectiveness of antibiotic therapy for septic patients in intensive care.
The purpose of the study was to investigate whether a novel assay of antibiotic efficacy could predict clinical outcome measures in septic patients in the intensive care unit (ICU). ⋯ This pilot study provides preliminary evidence that measurement of Tpos1 24 hours after the initiation of antibiotic therapy is associated with ICU length of stay and might be of value as a surrogate marker of antibiotic activity.
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Journal of critical care · Jun 2012
Lung-protective mechanical ventilation does not protect against acute kidney injury in patients without lung injury at onset of mechanical ventilation.
Preclinical and clinical studies suggest that mechanical ventilation contributes to the development of acute kidney injury (AKI), particularly in the setting of lung-injurious ventilator strategies. ⋯ In the present study in critically patients without ALI at onset of mechanical ventilation, lower tidal volume ventilation did not reduce the development or worsening of AKI compared with conventional tidal volume ventilation.