Critical care medicine
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Critical care medicine · Apr 2013
Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children.
To assess short-term neuropsychological function and academic performance in school children following admission to intensive care and to explore the role of critical neurologic and systemic infection. ⋯ Admission to intensive care is followed by deficits in neuropsychologic performance and educational difficulties, with more severe difficulties noted following meningoencephalitis and septic illness. These results highlight the importance of future studies on cognition and educational outcome incorporating type of illness as a moderating factor.
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Utilization of anemia tolerance reduces the need for and risks of perioperative transfusion. Recent publications indicate that the critical limit for oxygen supply might not be the same for each organ system. Therefore, we investigated the effects of acute dilutional anemia on heart, brain, kidneys, liver, small intestine, and skeletal muscle to quantify organ-specific tolerance of different levels of acute anemic hypoxia. We hypothesized that, in some organs, tissue hypoxia occurs before the critical limits of systemic oxygen supply are reached. ⋯ Heart, brain, kidneys, liver, small intestine, and skeletal muscle experience tissue hypoxia at different degrees of acute anemia, as assessed by the pimonidazole method and vascular endothelial growth factor expression. Further studies are needed to elucidate the mechanisms that determine organ-specific anemia tolerance.
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Critical care medicine · Apr 2013
Editorial CommentPandemic research in the ICU: always be prepared.
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Critical care medicine · Apr 2013
Severe sepsis cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population.
The epidemiology of severe sepsis is derived from administrative databases that rely on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to select cases. We compared the sensitivity of two code abstraction methods in identifying severe sepsis cases using a severe sepsis registry. ⋯ Patients admitted with severe sepsis and septic shock were incompletely documented and under-coded, using either ICD-9 code abstracting method. Documentation of subsequent coding of severe sepsis was more common in more severely ill patients. These findings are important when evaluating current national estimates and when interpreting epidemiologic studies of severe sepsis as cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population.
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Critical care medicine · Apr 2013
Comparative StudyPleural effusion in patients with acute lung injury: a CT scan study.
Pleural effusion is a frequent finding in patients with acute respiratory distress syndrome. To assess the effects of pleural effusion in patients with acute lung injury on lung volume, respiratory mechanics, gas exchange, lung recruitability, and response to positive end-expiratory pressure. ⋯ Pleural effusion in acute lung injury or acute respiratory distress syndrome patients is of modest entity and leads to a greater chest wall expansion than lung reduction, without affecting gas exchange or respiratory mechanics.