Journal of critical care
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Sepsis is a complicated syndrome in which proinflammatory and anti-inflammatory cytokines are expressed simultaneously. However, it remains unclear for the expression of interleukin (IL)-4 and IL-4delta2 in patients with severe sepsis. ⋯ The IL-4 mRNA expression might be associated with survival in patients with severe sepsis. The IL-4delta2/IL-4 ratio might be served as the net immunity of IL-4 activity.
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Journal of critical care · Dec 2008
Patient-specific decision modeling to guide the use of drotrecogin alpha (activated) in patients with severe sepsis.
The expected benefit of treating severe sepsis with drotrecogin alpha (activated) for an individual patient may depend upon several clinical factors including disease severity. Our objective was to create a decision support tool incorporating patient-specific inputs to estimate the balance between treatment risks and benefits for individual patients with severe sepsis. ⋯ A customizable decision model using patient-specific inputs can be used to inform the treatment decision when considering the use of drotrecogin alpha (activated) therapy by weighing the risks vs the benefits of therapy in the treatment of severe sepsis.
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Journal of critical care · Dec 2008
Hemodynamics and metabolic studies on septic shock in patients with acute liver failure.
Acute liver failure is often accompanied by hyperdynamic circulation, which is also a characteristic of septic shock. Pre-existing acute liver failure may worsen the hemodynamic impairment and prognosis in sepsis. ⋯ In patients with acute liver failure, septic shock was characterized by an accentuated hyperdynamic circulation, hyperlactatemia and an augmented renin-angiotensin-aldosterone system activity. Pre-existing liver failure has a significant impact on the disease severity of septic shock and portends a grave prognosis.
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Journal of critical care · Dec 2008
Evolving pathogens in the surgical intensive care unit: a 6-year experience.
Nosocomial infections in the intensive care unit (ICU) are well-known causes of morbidity and mortality in critically ill patients. Further complicating this issue is the ever-increasing number of multidrug-resistant pathogens. This study was designed to investigate and document changing microbial trends within the Los Angeles County/University of Southern California Medical Center surgical ICU (SICU), including drug-resistant pathogens. ⋯ Our study found that within the SICU, GP organisms play an increasing pathogenic role in critical patients. Staphylococcal species have become more common pathogens in the last 6 years, with an increase in the proportion of drug-resistant strains (oxacillin-resistant S aureus). These findings illustrate the need to keep constant surveillance on microbial trends within the SICU, especially those among drug-resistant pathogens.
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Journal of critical care · Dec 2008
Sepsis and organ system failure are major determinants of post-intensive care unit mortality.
The aim of the study was to investigate predictors of post-intensive care unit (ICU) in-hospital mortality with special emphasis on the impact of sepsis and organ system failure. ⋯ This large international study identified not only age, medical admission, and preexisting comorbidities on ICU admission but also sepsis and organ system failure as important independent risk factors for in-hospital post-ICU death.