Journal of critical care
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Journal of critical care · Oct 2012
African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients.
Acute kidney injury (AKI) is a common source of morbidity after trauma. We sought to determine novel risk factors for AKI, by Acute Kidney Injury Network (AKIN) criteria, in critically ill trauma patients. ⋯ Acute kidney injury in critically ill trauma patients is associated with substantial mortality. The findings of African American race, obesity, and blood product administration as independent risk factors for AKI deserve further study to elucidate underlying mechanisms.
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Journal of critical care · Oct 2012
Clinical TrialAdrenal insufficiency in cardiothoracic patients: an evaluation of the corticotrophin stimulation test and other diagnostic methods.
The purposes of the study were to determine the incidence of adrenal insufficiency (AI) using several published techniques, compare the response rates using a low-dose (LD) corticotropin (ACTH) stimulation test vs a standard dose (SD), and identify the technique that is most closely related to vasopressor use. ⋯ The incidence of AI will vary greatly based on technique used for diagnosis. The SD-ACTH stimulation test should be used to determine AI in open heart patients postoperatively because of the close association with vasopressor usage.
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Journal of critical care · Oct 2012
Lower serum endocan levels are associated with the development of acute lung injury after major trauma.
Endocan is a proteoglycan expressed by endothelial cells in the lung that may inhibit leukocyte recruitment and thus prevent the development of acute lung injury (ALI). We tested the association of serum endocan levels with subsequent development of ALI after major trauma. ⋯ Lower levels of serum endocan on admission are associated with subsequent development of ALI in trauma patients. These observations may be explained by endocan-mediated blockade of leukocyte recruitment in the lung.
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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
The role of total bile acid in oral secretions in ventilator-associated pneumonia.
The aim of this study was to investigate the role of inflammatory biomarkers and total bile acid (TBA) in oral secretions in the development of ventilator-associated pneumonia (VAP). ⋯ Duodenogastroesophageal reflux as evidenced by the presence of TBA in oral secretions is common in mechanically ventilated patients and may play a role in the development of VAP.