Critical care medicine
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Critical care medicine · Mar 2014
Randomized Controlled Trial Comparative StudyThe Glucoregulatory Benefits of Glucagon-Like Peptide-1 (7-36) Amide Infusion During Intensive Insulin Therapy in Critically Ill Surgical Patients: A Pilot Study.
Intensive insulin therapy for tight glycemic control in critically ill surgical patients has been shown to reduce mortality; however, intensive insulin therapy is associated with iatrogenic hypoglycemia and increased variability of blood glucose levels. The incretin glucagon-like peptide-1 (7-36) amide is both insulinotropic and insulinomimetic and has been suggested as an adjunct to improve glycemic control in critically ill patients. We hypothesized that the addition of continuous infusion of glucagon-like peptide-1 to intensive insulin therapy would result in better glucose control, reduced requirement of exogenous insulin administration, and fewer hypoglycemic events. ⋯ Glucagon-like peptide-1 (7-36) amide is a safe and efficacious form of adjunct therapy in patients with hyperglycemia in the surgical ICU setting. Improved stability of blood glucose is a favorable outcome, which enhances the safety of intensive insulin therapy. Larger studies of this potentially valuable therapy for glycemic control in the ICU are justified.
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Critical care medicine · Mar 2014
Multicenter Study Observational StudyImpact of Distinct Definitions of Acute Lung Injury on Its Incidence and Outcomes in Brazilian ICUs: Prospective Evaluation of 7,133 Patients.
Evaluation of prevalence and outcomes of acute lung injury in a large cohort of critically ill patients in Brazil and comparison of predictive receiver operating characteristic curve mortality of American European Consensus conference definition with new Berlin definition of acute respiratory distress syndrome. ⋯ In our population, prevalence of acute lung injury was low, most cases were diagnosed 2 days after ICU admission, and Berlin definition was not different from American European Consensus conference definition in predicting mortality. There are still several problems with the global epidemiology, definition, and mortality predictive indices that should be added to the classification of this still lethal syndrome to improve its predictive mortality power in the future.
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Critical care medicine · Mar 2014
Comparative StudyB-Type Natriuretic Peptide and Risk of Acute Kidney Injury in Patients Hospitalized With Acute Coronary Syndromes.
To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes. ⋯ In patients hospitalized with acute coronary syndromes, B-type natriuretic peptide levels measured at admission are associated with acute kidney injury as well as its severity.
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Critical care medicine · Mar 2014
Comparative StudyPediatric and Neonatal Extracorporeal Membrane Oxygenation: Does Center Volume Impact Mortality?
Extracorporeal membrane oxygenation, an accepted rescue therapy for refractory cardiopulmonary failure, requires a complex multidisciplinary approach and advanced technology. Little is known about the relationship between a center's case volume and patient mortality. The purpose of this study was to analyze the relationship between hospital extracorporeal membrane oxygenation annual volume and in-hospital mortality and assess if a minimum hospital volume could be recommended. ⋯ Pediatric centers with low extracorporeal membrane oxygenation average annual case volume had significantly higher mortality and a minimum volume of 22 cases per year was associated with improved mortality. We suggest that this threshold should be evaluated by additional study.