Critical care medicine
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Critical care medicine · May 2007
Neutrophil-derived S100A12 in acute lung injury and respiratory distress syndrome.
Both persistent accumulation and activation of neutrophils may contribute to the most severe form of acute lung injury, acute respiratory distress syndrome. We analyzed the expression of neutrophil-derived S100A12 and the proinflammatory receptor for advanced glycation end products (RAGE) in patients with acute respiratory distress syndrome. Additional in vivo and in vitro experiments were performed to further analyze the contribution of S100A12 to pulmonary inflammation. ⋯ S100A12 and its receptor RAGE are found at high concentrations in pulmonary tissue and bronchoalveolar lavage fluid in acute lung injury. S100A12 expression may reflect neutrophil activation during lung inflammation and contribute to pulmonary inflammation and endothelial activation via binding to RAGE.
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Critical care medicine · May 2007
Effect of lower limb compression devices on thermodilution cardiac output measurement.
The aim of this study was to determine whether lower limb (calf) sequential compression devices (SCDs) have a significant effect on thermodilution cardiac output measurements using a pulmonary artery catheter. ⋯ Thermodilution cardiac output measurements via a pulmonary artery catheter should not be done during the inflation cycle of lower limb SCDs because they produce a falsely low cardiac output.
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The current practice of critical care ultrasound worldwide and the potential that ultrasound holds for critical care patients is exciting and more advanced than many in the field would have suspected. This supplement has described a wide breadth of critical care ultrasound application that is unlikely to all be practiced by just one physician anywhere in the world. The urgency of incorporating ultrasound into critical care practice is almost palpable after reading the chapters making up this supplement, and the proposed curriculum will provide intensivists with a detailed roadmap for training. The future of critical care ultrasound will include development of protocols that cannot be derived from current traditional imaging practices and much research is still ahead of us.
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Accurate assessment and rapid decision-making are essential to save lives and improve performance in critical care medicine. Real-time point-of-care ultrasound has become an invaluable adjunct to the clinical evaluation of critically ill and injured patients both for pre- and in-hospital situations. However, a high level of quality is necessary, guaranteed by appropriate education, experience, credentialing, quality control, continuing education, and professional development. ⋯ The proposed curriculum is built on a competence, performance, and outcomes-based approach that is tailored to setting-specific training needs and prioritized according to critical problem-based pathways, rather than traditional organ-based systems. A multiple goal-oriented style fully addresses the specialty-specific approach of critical and intensive care professionals, who typically deal with disease states in complex scenarios rather than individual organ complaints. Because of the variation in the concept of what constitutes critical care worldwide, and the rate of change of information and technology, this manuscript attempts to present a learning system addressing a variety of needs for a rapidly changing world.
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Critical care medicine · May 2007
Recombinant human activated protein C inhibits local and systemic activation of coagulation without influencing inflammation during Pseudomonas aeruginosa pneumonia in rats.
Alveolar fibrin deposition is a hallmark of pneumonia. It has been proposed that recombinant human activated protein C exerts lung-protective effects via anticoagulant and anti-inflammatory pathways. We investigated the role of the protein C system in pneumonia caused by Pseudomonas aeruginosa, the organism that is predominantly involved in ventilator-associated pneumonia. ⋯ In patients with ventilator-associated pneumonia, the pulmonary protein C pathway is impaired at the site of infection, and local anticoagulant activity may be insufficient. Recombinant human activated protein C prevents procoagulant changes in the lung; however, it does not seem to alter the pulmonary host defense against P. aeruginosa pneumonia.