Journal of critical care
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Journal of critical care · Aug 2011
Persistent sepsis-induced hypotension without hyperlactatemia: is it really septic shock?
The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion. ⋯ Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.
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Journal of critical care · Aug 2011
Risk of cardiac arrhythmias and conduction abnormalities in patients with acute myocardial infarction receiving packed red blood cell transfusions.
Although transfusion has been linked to the development of atrial fibrillation (AF) in cardiac surgical patients, this association has not been investigated in patients with acute myocardial infarction (AMI). Evidence supports an inflammatory mechanism in the development of AF, and red cell transfusions also elicit an inflammatory response. We therefore sought to evaluate whether packed red blood cell transfusion increases the risk of AF, ventricular tachycardia (VT), and other arrhythmias and conduction abnormalities in patients with AMI. ⋯ Packed red blood cell transfusion is independently associated with an increased risk of new-onset cardiac arrhythmias and conduction abnormalities in the setting of AMI, even after controlling for traditional risk factors.
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Journal of critical care · Aug 2011
Extravascular lung water index and global end-diastolic volume index should be corrected in children.
The aim of the present study was to explain why extravascular lung water index (EVLWI) is higher and why global end-diastolic blood volume index (GEDVI) is lower in young children when measured with the PiCCO system (Pulsion, Munich, Germany). ⋯ Extravascular lung water index is higher and GEDVI is lower in young children because of changing organ-to-body weight relationships during growth.
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Journal of critical care · Aug 2011
The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury.
Endovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting. ⋯ Noninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.