Critical care medicine
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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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Critical care medicine · May 2007
Comparative StudyLevosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits: comparison with dobutamine and milrinone.
Current treatment strategies for severe septic conditions (i.e., intravenous fluids, vasopressors, and cardiac inotropes) reestablish fluid balance and improve cardiac systole but do not address diastolic dysfunction. Our study aimed to fully characterize both systolic and diastolic abnormalities of sepsis-associated heart failure and to identify treatment that would support full-cycle cardiac improvement. ⋯ Cardiac failure in severe sepsis results from impairments in both systolic and diastolic functions. Treatment with the calcium sensitizer levosimendan improved both systolic and diastolic cardiac functions in septic animals, but cyclic adenosine monophosphate-dependent inotropes milrinone and dobutamine only improved systolic function.
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Critical care medicine · May 2007
Economic implications of an evidence-based sepsis protocol: can we improve outcomes and lower costs?
To determine the financial impact of a sepsis protocol designed for use in the emergency department. ⋯ Use of a sepsis protocol can result not only in improved mortality but also in substantial savings for institutions and third party payers. Broader implementation of sepsis treatment protocols represents a potential means for enhancing resource use while containing costs.
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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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Critical care medicine · May 2007
IKappaB-kinase/nuclear factor-kappaB signaling prevents thermal injury-induced gut damage by inhibiting c-Jun NH2-terminal kinase activation.
The molecular mechanism of major burn-induced gut damage is not clear. This study is to determine whether IkappaB-kinase (IKK)/nuclear factor-kappaB signaling in intestinal mucosa maintains gut function through the regulation of the c-Jun NH2-terminal kinase (JNK) and p38 phosphorylation. ⋯ Thermal injury induces nuclear factor-kappaB activation of intestinal mucosa and IKK protects intestinal mucosa from thermal injury-induced gut damage. IKK blocks caspase 3 expression by up-regulating BCL-xL and cellular FLICE inhibitory protein expression. IKK inhibits JNK and p38 but not p44/42 phosphorylation of intestinal mucosa. JNK inhibition increases p38 and tumor necrosis factor receptor-associated factor 2 expression and decreases thermal injury-induced gut damage. Taken together with the enhanced thermal injury-induced gut damage by p38 inhibition, we conclude that IKK maintains gut function by inhibiting JNK phosphorylation, which suppresses p38 phosphorylation and induces gut damage.