Journal of critical care
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Journal of critical care · Jun 2011
Failure to achieve euglycemia despite aggressive insulin control signals abnormal physiologic response to trauma.
We hypothesize that a failure to normalize a patient's glucose on an automated euglycemia protocol signals an adverse response after trauma and that this response can identify patients with an increased mortality. ⋯ A posttraumatic patient's response to tight glycemic control revealed important prognostic information about the patients' physiologic status. Patients who failed to reach euglycemia in the first 6 hours of admission had an increased hospital mortality. The time to normalization is significantly longer in those patients who died. Patients who did not correct rapidly required significantly higher insulin doses, suggesting insulin resistance.
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Journal of critical care · Jun 2011
Multicenter StudyEarly changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.
The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. ⋯ Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Journal of critical care · Jun 2011
Randomized Controlled TrialMild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury.
The study aimed to investigate the association between blood glucose or lactate and the outcomes of severe traumatic brain injury (TBI), and to evaluate the effect of mild hypothermia therapy on glucose and lactate levels. ⋯ Hyperglycemia after TBI was associated with poor clinical outcomes, but the predictive value of blood lactate level requires further investigation. Hypothermia therapy improves neurologic outcomes in patients with severe TBI, and reduction in blood glucose may be partially responsible for the improved outcomes.
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Journal of critical care · Jun 2011
Respiratory impact of paracentesis in cirrhotic patients with acute lung injury.
Ascites may contribute to the loss of lung volume and alter the gas exchange in cirrhotic patients with acute lung injury (ALI). ⋯ In contrast to ventilatory recruitment maneuvers, paracentesis is a simple and well-tolerated technique able to improve oxygenation and alveolar recruitment without the risk of the lung overdistension in severely hypoxemic cirrhotic patients.
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Journal of critical care · Jun 2011
Intensive care unit admissions for community-acquired pneumonia are seasonal but are not associated with weather or reports of influenza-like illness in the community.
The aims of this study were to determine if there is seasonal variation in the number of intensive care unit (ICU) admissions for community-acquired pneumonia (CAP) and if there is a relationship between these admissions and weather or reports of influenza-like illness in the community. ⋯ Intensive care unit admissions for CAP are seasonal, but neither weather measurements nor weekly rate of reported influenza-like illness in the community is associated with these admissions.