Critical care medicine
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Critical care medicine · Feb 2009
Comparative StudyImmunosuppression associated with interleukin-1R-associated-kinase-M upregulation predicts mortality in Gram-negative sepsis (melioidosis).
Sepsis is associated with immunosuppression (characterized by a reduced capacity of circulating monocytes to release proinflammatory cytokines), which has been implicated in late mortality. Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an important cause of community-acquired sepsis in Southeast Asia with a mortality of up to 40%. Previous in vitro and murine studies have suggested a key role for the so-called negative regulators of the toll-like receptor (TLR) signaling pathway in immunosuppression. In this study, we investigated the expression of these negative TLR regulators in patients with septic melioidosis in association with the responsiveness of peripheral blood leukocytes of these patients to lipopolysaccharide and B. pseudomallei. ⋯ Immunosuppression in sepsis caused by B. pseudomallei is associated with an upregulation of IRAK-M and an indicator of poor outcome.
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Critical care medicine · Feb 2009
Case ReportsUnexplained hypotension: the spectrum of dynamic left ventricular outflow tract obstruction in critical care settings.
To illustrate the clinical and hemodynamic abnormalities caused by dynamic left ventricular outflow tract obstruction (LVOTO) in critical care setting. ⋯ LVOTO should be suspected especially in women presenting with hypotension and systolic murmur in critical care settings. Clinical acumen and timely echocardiography are required to effectively counter this transient but potentially lethal problem.
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Critical care medicine · Feb 2009
PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia.
To develop a severity assessment tool to predict mortality in community-acquired pneumonia (CAP) patients in intensive care unit (ICU), comparing its performance with Acute Physiology and Chronic Health Evaluation (APACHE) II score and American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) criteria as a prognostic index in CAP patients requiring ICU admission. ⋯ The PIRO score performed well as 28-day mortality prediction tool in CAP patients requiring ICU admission with a better performance than APACHE II and ATS/IDSA criteria in this subset of patients. Furthermore, PIRO score also is associated with increased healthcare resource utilization in CAP patients admitted in the ICU.
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Critical care medicine · Feb 2009
Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions.
Dynamic preload indicators like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly being used for optimizing cardiac preload since they have been demonstrated to predict fluid responsiveness in a variety of perioperative settings. However, in open-chest conditions, the value of these indices has not been systematically examined yet. We, therefore, evaluated the ability of PPV and SVV to predict fluid responsiveness under open- and closed-chest conditions. ⋯ Our results suggest that the dynamic preload indicators PPV and SVV are able to predict fluid responsiveness under closed-chest conditions, whereas all static and dynamic preload indicators fail to predict fluid responsiveness under open-chest conditions.
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Critical care medicine · Feb 2009
Early blood glucose control and mortality in critically ill patients in Australia.
To measure temporal trends in blood glucose (BG) control and describe their association with hospital mortality in a cohort of critically ill patients from Australia. ⋯ In a large cohort of ICU patients from Australia, there was no significant change in early glycemic control from 2000 to 2005. There were differences in selected subgroups. Average BG decreased in surgical subgroups, whereas it increased in septic patients. Both high and early low BG values were independently associated with hospital mortality.