Critical care medicine
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Critical care medicine · Jun 2007
Multicenter StudyCombination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock.
To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock. ⋯ Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.
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To review mechanisms underlying sepsis-induced cardiac dysfunction in general and intrinsic myocardial depression in particular. ⋯ Integrative studies are needed to distinguish the hierarchy of the various mechanisms underlying septic cardiac dysfunction. As many of these changes are related to severe inflammation and not to infection per se, a better understanding of septic myocardial dysfunction may be usefully extended to other systemic inflammatory conditions encountered in the critically ill. Myocardial depression may be arguably viewed as an adaptive event by reducing energy expenditure in a situation when energy generation is limited, thereby preventing activation of cell death pathways and allowing the potential for full functional recovery.
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Critical care medicine · Jun 2007
Pronounced elevation of resistin correlates with severity of disease in severe sepsis and septic shock.
Resistin induces insulin resistance in mice. In humans, recent data suggest that resistin functions as a proinflammatory cytokine. Here, we studied resistin up to 2 wks after admission in patients with septic shock and/or severe sepsis. ⋯ This is the first study assessing systemic levels of resistin in patients with septic shock/severe sepsis. We show that resistin is a marker of severity of disease and possibly a mediator of the prolonged inflammatory state seen in infected critically ill patients. Further exploration of resistin as a therapeutic target and marker of disease is merited.