Critical care medicine
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Critical care medicine · May 2009
Multicenter StudyEpidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006).
To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). ⋯ More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.
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Critical care medicine · May 2009
Randomized Controlled Trial Comparative StudyStress doses of hydrocortisone in high-risk patients undergoing cardiac surgery: effects on interleukin-6 to interleukin-10 ratio and early outcome.
Severe systemic inflammation (systemic inflammatory response syndrome) associated with cardiac surgery often leads to a worse short-term and long-term outcome. Stress doses of hydrocortisone have been successfully used to improve outcome of CS. The interleukin (IL)-6 to IL-10 ratio is associated with outcome after trauma and major surgery. ⋯ Stress doses of hydrocortisone attenuate the evolution of IL-6/IL-10 ratio in patients with systemic inflammatory response syndrome after CS, which seems to be associated with an improved outcome. The immunologic effects of hydrocortisone may thus be both, inhibitory (IL-6) and permissive (IL-10), regarding the immune response.
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Critical care medicine · May 2009
Multicenter Study Comparative StudyDifferences in immune response may explain lower survival among older men with pneumonia.
Lower life expectancy in men is generally attributed to higher likelihood of risky behavior and because men develop chronic conditions earlier. If sex-related differences in survival are independent of preinfection chronic health and health behavior, it would suggest that survival differences may occur because of sex differences in quality of care and biological response to infection, and these differences may contribute to sex differences in life expectancy. We assessed if sex-related survival difference following community-acquired pneumonia (CAP) is due to differences in clinical characteristics, quality of care, or immune response. ⋯ Lower survival among men following CAP was not explained by differences in chronic diseases, health behaviors, and quality of care. Patterns of inflammatory, coagulation, and fibrinolysis biomarkers among men may explain reduced short-term and long-term survival.
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Critical care medicine · May 2009
Comparative StudyProspective validation of the intensive care unit admission Mortality Probability Model (MPM0-III).
To validate performance characteristics of the intensive care unit (ICU) admission mortality probability model, version III (MPM0-III) on Project IMPACT data submitted in 2004 and 2005. This data set was external from the MPM0-III developmental and internal validation data collected between 2001 and 2004. ⋯ MPM0-III calibrates on a new population of 55,459 North American patients who include many patients from new ICUs, which helps confirm that the model is robust and was not overfitted to the development sample. Although Project IMPACT participants change over time, 2004-2005 patient risk factors and their relationship to hospital mortality have not significantly changed. The increase in mechanically ventilated patients and reduction in admissions with no risk factors are trends worth following.
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Critical care medicine · May 2009
Comparative StudySerum lactate is associated with mortality in severe sepsis independent of organ failure and shock.
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension). ⋯ Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.