Critical care medicine
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Critical care medicine · Feb 2009
Randomized Controlled Trial Multicenter StudyTherapeutic hypothermia preserves antioxidant defenses after severe traumatic brain injury in infants and children.
Oxidative stress contributes to secondary damage after traumatic brain injury (TBI). Hypothermia decreases endogenous antioxidant consumption and lipid peroxidation after experimental cerebral injury. Our objective was to determine the effect of therapeutic hypothermia on oxidative damage after severe TBI in infants and children randomized to moderate hypothermia vs. normothermia. ⋯ To our knowledge, this is the first study demonstrating that hypothermia attenuates oxidative stress after severe TBI in infants and children. Our data also support the concept that CSF represents a valuable tool for monitoring treatment effects on oxidative stress after TBI.
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Critical care medicine · Feb 2009
Randomized Controlled Trial Multicenter StudyTight glycemic control may favor fibrinolysis in patients with sepsis.
To investigate whether tight glycemic control, in patients with sepsis, may restore a normal fibrinolysis by lowering plasminogen activator inhibitor (PAI)-1 levels. ⋯ Fibrinolysis inhibition, in severe sepsis/septic shock, seems to have a relevant pathogenetic role. In this context, tight glycemic control seems to reduce, with time, the fibrinolytic impairment and morbidity.
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Critical care medicine · Feb 2009
ReviewCritical care checklists, the Keystone Project, and the Office for Human Research Protections: a case for streamlining the approval process in quality-improvement research.
Checklists have been recently promulgated as a method to enhance patient safety and improve outcomes for critically ill patients. Specifically, recent work performed by researchers from the Johns Hopkins Medical Institutions has demonstrated that the addition of checklists to usual care in the intensive care unit is associated with a decrease in the incidence of catheter-related bloodstream infections. ⋯ Although this work has recently received significant positive attention in the lay press, the Office for Human Research Protections--as they felt that this was a research project requiring Institutional Review Board approval and informed consent--put the data collection on hold for lack of approval by the Institutional Review Board at the participating hospitals in Michigan as well as for not having obtained informed consent from each patient and clinician involved in the project. This article documents the recent events surrounding the Keystone Project and the response to the actions taken by the Office for Human Research Protections in the lay press and the new media (Internet and blogs), articulates how a determination can be made if a project is quality-improvement, human-subjects research, or both, and proposes some solutions to create a structured approach to this kind of research in the future.
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Critical care medicine · Feb 2009
Cerebral desaturation during cardiac arrest: its relation to arrest duration and left ventricular pump function.
To determine the impact of brief periods of cardiac arrest (CA) on regional cerebral oxygen saturation (rSO2) in patients with low left ventricular ejection fraction (LVEF <30%). ⋯ These findings demonstrate that severely compromised left ventricular pump function is associated with diminished rSO2. As these patients seem to be more susceptible to critical desaturations, they may be prone to severe tissue hypoxemia unless adequate oxygen delivery is reestablished rapidly. This may contribute to the poor neurologic outcome after successful resuscitation in patients with LVEF <30%.
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Critical care medicine · Feb 2009
Randomized Controlled TrialEffects of early vital capacity maneuver on respiratory variables during multivessel off-pump coronary artery bypass graft surgery.
Despite avoiding cardiopulmonary bypass, similar degrees of pulmonary impairment compared with on-pump coronary artery bypass surgery have been demonstrated in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) compared with on-pump coronary artery bypass surgery. To investigate the effects of an early vital capacity maneuver (VCM) on intrapulmonary shunt (Qs/Qt), oxygenation, and pulmonary outcome in OPCAB. ⋯ The beneficial effects of an early VCM on Qs/Qt persisted into the period of ICU care, with an improvement in P/F ratio and preserved pulmonary compliances, leading to a shorter time to extubation.