Journal of critical care
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Journal of critical care · Jun 2012
Does body weight impact the efficacy of vasopressin therapy in the management of septic shock?
Vasopressors used for the management of septic shock are often dosed according to body weight. Use of vasopressin for physiologic replacement in patients with septic shock is usually administered as a standard non-weight-based dose. We hypothesized that the efficacy of vasopressin may be influenced by body weight. ⋯ Effects of vasopressin on catecholamine dosing requirements in the setting of septic shock may be influenced by body weight. Prospective studies are needed to examine weight-based dosing of vasopressin in this setting.
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Journal of critical care · Jun 2012
Endothelial dysfunction assessed by brachial artery ultrasound in severe sepsis and septic shock.
Noninvasive evaluation of endothelial function may be accomplished by ultrasound assessment of flow-mediated vasodilation (FMD) of the brachial artery. This study aims to investigate the role of FMD analysis on intrahospital prognosis of patients with sepsis. ⋯ Brachial FMD is altered in septic patients with hemodynamic instability, and its deterioration may be an early marker of unfavorable prognosis.
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Journal of critical care · Jun 2012
Comparative StudyEndoscopically directed middle meatal cultures vs computed tomographic scans in the diagnosis of bacterial sinusitis in intensive care units.
The objective of the study was to evaluate the accuracy of endoscopically directed middle meatal cultures in the diagnosis of bacterial sinusitis in intensive care unit (ICU) patients in comparison with computed tomographic (CT) scans. ⋯ The data of the present study indicated that endoscopically directed middle meatal cultures had high positive and negative predictive values and accurately diagnosed bacterial sinusitis and identified the causative bacteria with high sensitivity and specificity in comparison with the criterion standard CT scans. The procedure is simple, noninvasive, and can be easily performed at the bedside without discomfort or morbidity. Based on our data, the procedure can be considered as a trustworthy substitute to sinus CT scans in ICU patients especially when it is difficult to transport the patients for imaging. Computed tomographic scans can, therefore, be reserved for patients who do not respond to culture-specific antibiotherapy. A further advantage of this approach is avoidance of the cumulative effect of unnecessary radiation. The study also confirmed the role of nasogastric and nasotracheal intubation in the pathogenesis of ICU sinusitis.
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Journal of critical care · Jun 2012
Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients.
The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTI(LVOT)) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTI(LVOT) compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population. ⋯ In contrast to CVP, GEDVI and ΔVTI(LVOT) reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.
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Journal of critical care · Jun 2012
Impaired renal function is associated with greater urinary strong ion differences in critically ill patients with metabolic acidosis.
Urinary excretion of chloride corrects metabolic acidosis, but this may be hampered in patients with impaired renal function. We explored the effects of renal function on acid-base characteristics and urinary strong ion excretion using the Stewart approach in critically ill patients with metabolic acidosis. ⋯ In critically ill patients with metabolic acidosis, impaired renal function was associated with greater urinary SIDs. Subsequently, the higher urinary SIDs values were related to lower pH levels, illustrating the importance of renal chloride excretion to correct for acidosis.