Critical care medicine
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Critical care medicine · Apr 2006
CommentCritical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations.
To describe the organization and distribution of intensive care unit (ICU) patients and services in the United States and to determine ICU physician staffing before the publication and dissemination of the Leapfrog Group ICU physician staffing recommendations. ⋯ ICU services are widely distributed but heterogeneously organized in the United States. Although high-intensity ICUs have been associated previously with improved outcomes, they were infrequent in our study, especially in smaller hospitals, and virtually no ICU met the Leapfrog standards before their dissemination. These findings highlight the considerable challenge to any efforts designed to promote either 24-hr physician coverage or high-intensity model organization.
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Critical care medicine · Apr 2006
CommentMorbid obesity is an independent determinant of death among surgical critically ill patients.
To determine whether extreme obesity (morbid obesity; body mass index > or =40 kg/m(2)) is an independent risk factor for death among critically ill patients; this objective is most salient in the subset of patients who sustain a prolonged intensive care unit stay during which the burdens of care imposed by obesity and its consequences would become most apparent. ⋯ Morbid obesity (body mass index > or =40 kg/m(2)) is an independent risk factor for death in surgical patients with catastrophic illness requiring prolonged intensive care. The prevalence of obesity is growing, both in the intensive care unit and in the general population. The increased risk of complications and death in this population mandates that we adapt customized processes of care to specifically address this unique and very challenging subset of patients.
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Critical care medicine · Apr 2006
Down-modulation of granulocyte macrophage-colony stimulating factor receptor on monocytes during human septic shock.
Loss of surface human leukocyte antigen-DR (HLA-DR) on monocytes is a major factor of immunosuppression in sepsis. Granulocyte macrophage-colony stimulating factor (GM-CSF) up-regulates HLA-DR expression on monocytes via the GM-CSF receptor (GM-CSFr) through a transcriptional mechanism involving the class II transactivator factor (CIITA). We investigated monocyte GM-CSFr expression and its relationship with HLA-DR in septic patients. ⋯ Monocyte GM-CSFr down-modulation occurred in septic shock, was associated with severity, and might be either another manifestation of monocyte deactivation linked to sepsis or an additional mechanism participating in immunosuppression.
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Critical care medicine · Apr 2006
CommentPlasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortality.
The purpose of the present study was to evaluate the prognostic implications of perioperative B-type natriuretic peptide (BNP) and cardiac troponin I concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. ⋯ Postoperative plasma BNP and cardiac troponin I levels are independent predictors of postoperative cardiac dysfunction after cardiac surgery. Simultaneous measurement of BNP and cardiac troponin I improve the risk assessment of postoperative cardiac dysfunction. However, the association between BNP levels and 1-yr outcome was no longer significant after adjustment on left ventricular ejection fraction.
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Critical care medicine · Apr 2006
CommentPolymorphism of the angiotensin-converting enzyme gene affects the outcome of acute respiratory distress syndrome.
There has been increasing evidence that angiotensin II may play an important role in the pathogenesis and in the evolution of acute lung injury. It was therefore hypothesized that polymorphisms of the angiotensin-converting enzyme gene affects the risk and outcome of acute respiratory distress syndrome (ARDS). ⋯ The angiotensin-converting enzyme I/D polymorphism is a significant prognostic factor for the outcome of ARDS. Patients with the II genotype have a significantly better chance of survival. This study did not show an increased risk for ARDS in Chinese patients with the D allele.