Critical care medicine
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Critical care medicine · May 2007
ReviewUltrasound imaging techniques for regional blocks in intensive care patients.
Ultrasound imaging techniques have gained great popularity in anesthesia during the last decade. They have been shown to allow better quality of regional blocks, improving the outcome of patients and reducing the costs at the same time, for two major reasons. First, ultrasound imaging provides information of the individual anatomic structure and abnormalities before puncture. ⋯ Even positioning dependent variations of nerve roots can be managed most effectively. In addition, the time can be reduced considerably to perform regional blocks; the onset time is shorter, and the quality of blocks is better. So, ultrasound imaging techniques are routinely applied in the University Clinics Bergmannsheil, Bochum, Germany.
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Critical care medicine · May 2007
Comparative StudyIs all ventricular fibrillation the same? A comparison of ischemically induced with electrically induced ventricular fibrillation in a porcine cardiac arrest and resuscitation model.
The standard porcine cardiac arrest model uses electrical induction of ventricular fibrillation. Reported restoration of spontaneous circulation and survival rates in this model are as high as 90% for ventricular fibrillation durations of 7-10 mins, values substantially greater than rates in the clinical population (i.e., 20% to 30%). A high first shock success rate, infrequent refibrillation, and short times for restoration of spontaneous circulation are typical of the model. The purpose of this study was to determine whether ischemic induction of ventricular fibrillation in swine followed by standard advanced cardiac life support would result in short-term outcomes approximating those observed in human victims of out-of-hospital ventricular fibrillation. ⋯ Resuscitation from ischemic ventricular fibrillation is more difficult than electrical ventricular fibrillation and is characterized by greater time to restoration of spontaneous circulation, frequent refibrillation, greater number of countershocks, higher epinephrine dose during resuscitation efforts, profound cardiac dysfunction, and a short-term survival rate approaching clinical experience. Ischemically induced ventricular fibrillation is a more clinically relevant model for the evaluation of resuscitation interventions.
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Critical care medicine · May 2007
Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock.
The aim of this study was to evaluate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality in a large, unselected patient population with severe sepsis and septic shock. ⋯ NT-proBNP values are frequently increased in severe sepsis and septic shock. Values are significantly higher in nonsurvivors than survivors. NT-proBNP on day 3 in the intensive care unit is an independent prognostic marker of mortality in severe sepsis.
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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
Simple triage scoring system predicting death and the need for critical care resources for use during epidemics.
In the event of pandemic influenza, the number of critically ill victims will likely overwhelm critical care capacity. To date, no standardized method for allocating scarce resources when the number of patients in need far exceeds capacity exists. We sought to derive and validate such a triage scheme. ⋯ If, as expected, patient demand far exceeds the capability to provide critical care services in an epidemic, a fair and just system to allocate limited resources will be essential. The triage rule we have developed can serve as an initial guide for such a process.