Critical care medicine
-
Critical care medicine · Nov 2008
Transthoracic application of electrical cardiopulmonary resuscitation for treatment of cardiac arrest.
Observational studies have shown that muscular stimulation contracting the thoracic cage may produce coronary perfusion pressures equal to manual chest compressions. This study examined electrical cardiopulmonary resuscitation for coronary perfusion pressures during ventricular fibrillation in a porcine model of cardiac arrest. ⋯ Optimal skeletal-based and cardiac-based electrical cardiopulmonary resuscitation pulse train parameters generated levels of coronary perfusion pressure significantly greater than ventricular fibrillation and comparable with manual chest compression over a short interval of untreated cardiac arrest.
-
Critical care medicine · Nov 2008
Glycemic variability: a strong independent predictor of mortality in critically ill patients.
To determine the effect of glycemic variability, assessed by the standard deviation of each patient's mean glucose level, on mortality in a population of critically ill adult patients. ⋯ This study demonstrates that increasing glycemic variability conferred a strong independent risk of mortality in this heterogeneous population of critically ill patients. Previously published interventional studies of glycemic control may be reinterpreted using the metric of glycemic variability. Measures to ensure a low degree of glycemic variability may improve outcomes in intensive care unit's implementing glycemic control. Finally, ongoing and future investigations should consider including this new metric in their study design.
-
Critical care medicine · Nov 2008
Modulation of aquaporin-2/vasopressin2 receptor kidney expression and tubular injury after endotoxin (lipopolysaccharide) challenge.
Sepsis-induced organ dysfunctions remain prevalent and account for >50% of intensive care unit admissions for acute renal failure with a mortality rate nearing 75%. In addition to the fact that the mechanisms underlying the pathophysiology of sepsis-related acute renal failure are unclear, the impact on septic-induced acute renal failure of either norepinephrine, a gold-standard vasopressor, and arginine vasopressin, a candidate alternative, are not well understood. ⋯ In this endotoxic model, dose-targeted arginine vasopressin infusion increased lipopolysaccharide-induced renal dysfunction without affecting renal blood flow and glomerular function, but with particular disruption of aquaporin-2/V2 receptor networking, consecutive decreased salt and water handling ability. This is in clear contrast with norepinephrine infusion and suggests specific arginine vasopressin-induced "tubular epithelial dysfunction."
-
Critical care medicine · Nov 2008
Intra-arrest rapid head cooling improves postresuscitation myocardial function in comparison with delayed postresuscitation surface cooling.
To compare resuscitation outcomes and myocardial function among intra-arrest head cooling, delayed surface cooling, and uncooled controls. ⋯ Both intra-arrest head cooling and delayed surface cooling improved postresuscitation myocardial dysfunction. The beneficial effects were greatest with head cooling initiated with cardiopulmonary resuscitation.