Critical care medicine
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Critical care medicine · Mar 2006
Oxidative variables in the rat brain after sepsis induced by cecal ligation and perforation.
The underlying mechanisms of the changes in mental status, septic encephalopathy, and long-term cognitive symptoms in sepsis survivors have only been defined in part. The present study was undertaken to assess different variables of oxidative stress in several brain structures after cecal ligation and perforation in the rat. ⋯ The short-term oxidative damage demonstrated here could participate in the development of central nervous system symptoms during sepsis development, or even septic encephalopathy. The alterations in the superoxide dismutase/catalase relation were temporally related to the occurrence or not of oxidative damage in the central nervous system.
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Critical care medicine · Mar 2006
Pulmonary cytomegalovirus reactivation causes pathology in immunocompetent mice.
Cytomegalovirus (CMV) is a ubiquitous herpes virus that persists in the host in a latent state following primary infection. We have recently observed that CMV reactivates in lungs of critically ill surgical patients and that this reactivation can be triggered by bacterial sepsis. Although CMV is a known pathogen in immunosuppressed transplant patients, it is unknown whether reactivated CMV is a pathogen in immunocompetent hosts. Using an animal model of latency/reactivation, we studied the pathobiology of CMV reactivation in the immunocompetent host. ⋯ This study shows that CMV reactivation causes abnormal tumor necrosis factor-alpha expression, and that following CMV reactivation, immunocompetent mice have abnormal pulmonary fibrosis. Ganciclovir blocks MCMV reactivation, thus preventing abnormal tumor necrosis factor-alpha expression and pulmonary fibrosis. These data may explain a mechanism by which critically ill surgical patients develop fibroproliferative acute respiratory distress syndrome. These data suggest that human studies using antiviral agents during critical illness are warranted.
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Critical care medicine · Mar 2006
Interleukin-6 treatment reverses apoptosis and blunts susceptibility to intraperitoneal bacterial challenge following hemorrhagic shock.
Resuscitation from hemorrhagic shock (HS) predisposes to subsequent infections. Susceptibility to infection following sepsis has been attributed to apoptosis. Interleukin (IL)-6 has been shown to have antiapoptotic properties and to decrease postresuscitation inflammation in rodent and porcine models of HS. ⋯ IL-6 treatment at resuscitation eliminated the HS-mediated increase in total and liver bacterial burden and protected the liver from HS-induced apoptosis. Reduced liver apoptosis may explain the ability of IL-6 to blunt the HS-induced increase in susceptibility to bacterial challenge.
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This panel featured four representatives from the healthcare industry and government, offering an opportunity for critical care professionals to pose questions and discuss issues and concerns relevant to anyone caring for critically ill and injured patients today. A brief biography is provided for each panelist. ⋯ Each of the panelists provided a prepared statement on issues relevant to critical care, as evident from their respective roles. Specific scenarios and other suggestions regarding payment policy, coding, and quality of care are provided.
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Although respiratory care is a relatively new profession, its practitioners are deeply involved in providing patient care in the critical care. In preparation for writing this article, we sought to explore the respiratory therapy manpower needs and activities designed to fulfill those needs in critical care practice. ⋯ This article provides a short history of the development of respiratory care and its historical relationship with critical care. We have, perhaps for the first time, provided a unified data set of key demographic information from the three professional bodies guiding the development of the respiratory therapy profession. This data set provides time-linked data on admissions and graduations from the CoARC, membership numbers for the AARC, and the numbers of active credentialed RCP from the NBRC. By two focused surveys, we were able to show that while mandatory overtime is a common practice in respiratory care departments, it was not overwhelming utilized. We also learned that in most hospitals, regardless of bed size, there is a perceived need for 1.3 RCPs more than the actual staff and that it appears that the critical staffing level between actual to preferred RCP to beds is between 9 and 11 beds.