Critical care medicine
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Critical care medicine · Nov 2010
Review Meta AnalysisStress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis.
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 hrs of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection. ⋯ The results of this meta-analysis suggest that, in those patients receiving enteral nutrition, stress ulcer prophylaxis may not be required and, indeed, such therapy may increase the risk of pneumonia and death. However, because no clinical study has prospectively tested the influence of enteral nutrition on the risk of stress ulcer prophylaxis, our findings should be considered exploratory and interpreted with some caution.
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Critical care medicine · Nov 2010
Comparative StudyErythropoietin is equally effective as fresh-blood transfusion at reducing infarct size in anemic rats.
We recently demonstrated that transfusion of anemic animals up to 100 g/L hemoglobin with fresh blood protects the heart from ischemic injuries following myocardial infarction. Erythropoietin has cardioprotective effects independent of its erythropoietic activity. The objective of this study was to compare the cardioprotective effects of erythropoietin treatment to fresh-blood transfusion in anemic rats after acute myocardial infarction. ⋯ Erythropoietin treatment is equally effective as fresh-blood transfusion in anemic rats after acute myocardial infarction at reducing infarct size, myocardial apoptosis, and improving cardiac function.
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Critical care medicine · Nov 2010
Randomized Controlled TrialC1-esterase inhibitor attenuates the inflammatory response during human endotoxemia.
Besides its role in regulation of the complement and contact system, C1-esterase inhibitor has other immunomodulating effects that could prove beneficial in patients with acute inflammation such as during sepsis or after trauma. We examined the immunomodulating properties of C1-esterase inhibitor during human experimental endotoxemia, in which the innate immune system is activated in the absence of activation of the classic complement pathway. ⋯ This study is the first to demonstrate that C1-esterase inhibitor exerts anti-inflammatory effects in the absence of classic complement activation in humans.
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Critical care medicine · Nov 2010
Randomized Controlled TrialFluids after cardiac surgery: a pilot study of the use of colloids versus crystalloids.
To determine whether a starch solution for volume resuscitation in a flow-based protocol improves circulatory status better than a crystalloid solution, as defined by the need for catecholamines in patients the morning after cardiac surgery, and whether this can be performed without increased morbidity. ⋯ Use of a colloid solution for volume resuscitation in a nurse-delivered flow-based algorithm, which included a pulmonary artery catheter, significantly improved hemodynamic status, an important factor for readiness for discharge from the intensive care unit.
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Critical care medicine · Nov 2010
Randomized Controlled TrialFeasibility of physical and occupational therapy beginning from initiation of mechanical ventilation.
Physical and occupational therapy are possible immediately after intubation in mechanically ventilated medical intensive care unit patients. The objective of this study was to describe a protocol of daily sedative interruption and early physical and occupational therapy and to specify details of intensive care unit-based therapy, including neurocognitive state, potential barriers, and adverse events related to this intervention. ⋯ Early physical and occupational therapy is feasible from the onset of mechanical ventilation despite high illness acuity and presence of life support devices. Adverse events are uncommon, even in this high-risk group.