Critical care medicine
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Critical care medicine · Jun 2000
Observations of withdrawal of life-sustaining treatment from patients who became non-heart-beating organ donors.
Non-heart-beating organ donation for transplantation is increasing despite the concern whether all the donors are dead. This concern is based on the adequacy of documentation of death and the appropriate duration that circulation and respiration should be absent before death certification. No studies have examined the documentation and deaths of patients who became non-heart-beating organ donors. ⋯ In a small study of non-heart-beating organ donation, circulation never resumed after >1 min of absent circulation, suggesting that 2 mins of absent circulation is sufficient to certify death. Three of 15 patients had inadequate documentation. Gaps and inconsistencies in documentation may raise concern about the potential for abuse.
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Critical care medicine · Jun 2000
Whole blood tumor necrosis factor-alpha production and its relation to systemic concentrations of interleukin 4, interleukin 10, and transforming growth factor-beta1 in multiply injured blunt trauma victims.
To study the relation of whole blood endotoxin responsiveness to inhibitory mediators systemically released after severe blunt trauma. ⋯ Whole blood hyporesponsiveness to endotoxin in multiply injured patients is caused by soluble serum factors systemically released after trauma, whereas the intrinsic leukocyte function appears unaffected. Inhibitory mediators other than IL-4, IL-10, or TGF-beta1 are supposed to be of major biological relevance for the posttraumatic regulation of leukocyte function. Characterization of the causative suppressive mediators is supposed as a prerequisite for the development of immunologically based therapeutic approaches in critically ill patients.
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To study the incidence and prognosis of thrombocytopenia in adult intensive care unit (ICU) patients. ⋯ Thrombocytopenia is common in ICUs and constitutes a simple and readily available risk marker for mortality, independent of and complementary to established severity of disease indices. Both a low nadir platelet count and a large fall of platelet count predict a poor vital outcome in adult ICU patients.
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Critical care medicine · Jun 2000
Risk assessment and standardized nosocomial infection rate in critically ill children.
To develop and validate a pediatric nosocomial infection risk (PNIR) assessment model, and to compare the daily trends in risk factors between patients with nosocomial infection (cases) and without nosocomial infection (controls) in the pediatric intensive care unit (ICU). ⋯ The PNIR assessment model incorporates intrinsic factors, such as patient severity of illness, and extrinsic factors contributing to the development of nosocomial infection in this high-risk population. The methodology using intrinsic and extrinsic factors to adjust for nosocomial infections should be taken into consideration when evaluating interhospital comparison of nosocomial infection rates, quality assessment, intervention strategies, and use of treatment modalities.
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Critical care medicine · Jun 2000
Linear and nonlinear analysis of hemodynamic signals during sepsis and septic shock.
Neuroautonomic modulation of heart rate (HR) and blood pressure were assessed in sepsis or septic shock. We hypothesized that these metrics would be diminished in pediatric patients with sepsis and septic shock, indicating uncoupling of the autonomic and cardiovascular systems. ⋯ We conclude that uncoupling of the autonomic and cardiovascular systems occurs over both short- and long-range time scales during sepsis, and the degree of uncoupling may help differentiate between sepsis, septic shock, and recovery states.