Critical care medicine
-
Neutrophils are an important component of the inflammatory response that characterizes acute lung injury (ALI). This discussion aims to review the contribution of neutrophils to the development and progression of ALI and to highlight the major intracellular signaling pathways that are involved in neutrophil activation in the setting of ALI. ⋯ The accumulation of activated neutrophils in the lungs is an early step in the pulmonary inflammatory process that leads to ALI. Although experimental models indicate that the activation of p38, Akt, and nuclear factor-kappaB in neutrophils contributes to ALI, the relative importance of these pathways in critically ill patients remains to be determined. Nevertheless, modulation of the activation of p38, Akt, and nuclear factor-kappaB in neutrophils appears to be an appropriate therapeutic target in severely ill patients with ALI.
-
Critical care medicine · Apr 2003
ReviewChronic alcohol abuse, acute respiratory distress syndrome, and multiple organ dysfunction.
To review the effects of chronic alcohol abuse on the incidence, severity, and pathogenesis of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. ⋯ Chronic alcohol abuse is associated with an increased incidence of ARDS and the severity of multiple organ dysfunction. This research has implications in understanding the diagnosis of, and prognosis for, critically ill patients who are at risk of developing ARDS. It also may lead to the development of novel therapies for those patients at greatest risk of acute lung injury as a consequence of chronic alcohol abuse.
-
Critical care medicine · Apr 2003
Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients.
The impact of resistant (vs. nonresistant) Gram-negative infections on mortality remains unclear. We sought to define risk factors for and excess mortality from these infections. ⋯ rGNRs are associated with prolonged hospital stay and increased mortality. Infection with rGNRs independently predicts mortality; however, this may be more closely related to selection of certain bacterial species with a high frequency of resistance rather than actual resistance to antibiotic therapy. Therefore, altering infection-control practices to limit the dissemination of certain bacterial species may be more effective than attempts to control only antibiotic-resistant isolates.
-
Critical care medicine · Apr 2003
Six-month neuropsychological outcome of medical intensive care unit patients.
To examine neuropsychological function, depression, and quality of life 6 months after discharge in patients who received mechanical ventilation in the intensive care unit. ⋯ Prolonged neuropsychological impairment is common among survivors of the medical intensive care unit and occurs with greater than anticipated frequency when compared with relevant normative data. Future investigations are warranted to elucidate the nature of the association between critical illness, neuropsychological impairment, depression, and decreased quality of life.
-
Critical care medicine · Apr 2003
Comparative StudyHealth-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population.
To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction. ⋯ This study has shown that preadmission health-related quality of life of our medical, noncoronary patients was substantially reduced compared with a matched general population. This demonstrates the need to take prehospitalization health-related quality of life into account when examining the outcomes of intensive care unit survivors. Multiple organ dysfunction was the major determinant of poor physical health at follow-up, but it had no impact on mental health domains.