Critical care medicine
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Critical care medicine · May 2014
Multicenter Study Observational StudySex- and Diagnosis-Dependent Differences in Mortality and Admission Cytokine Levels Among Patients Admitted for Intensive Care.
To investigate the role of sex on cytokine expression and mortality in critically ill patients. ⋯ The relationship between sex and outcomes in critically ill patients is complex and depends on underlying illness. Women appear to be better adapted to survive traumatic events, while sex may be less important in other forms of critical illness. The mechanisms accounting for this gender dimorphism may, in part, involve differential cytokine responses to injury, with men expressing a more robust proinflammatory profile.
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Critical care medicine · May 2014
Multicenter Study Observational StudyA Multinational Study of Thromboprophylaxis Practice in Critically Ill Children.
Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated. ⋯ Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.
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Critical care medicine · May 2014
ReviewThe highs and lows of blood pressure: toward meaningful clinical targets in patients with shock.
Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock. ⋯ This article discusses the implications of these points and explores factors that need to be taken into account when designing empiric trials to determine appropriate blood pressure targets for patients in shock. Even if well-studied empirically developed guidelines become available, it likely still will be important to individualize patient management and approaches for this are discussed too.
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Critical care medicine · May 2014
Observational StudyRisk Factors for Postoperative Pneumonia After Cardiac Surgery and Development of a Preoperative Risk Score.
The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia. ⋯ Assessing preoperative risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).
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Critical care medicine · May 2014
Transient Receptor Potential Melastatin 8 Channel Inhibition Potentiates the Hypothermic Response to Transient Receptor Potential Vanilloid 1 Activation in the Conscious Mouse.
Mild decrease in core temperature (therapeutic hypothermia) provides lasting neuroprotection following cardiac arrest or cerebral ischemia. However, current methods for producing therapeutic hypothermia trigger a cold-defense response that must be countered by sedatives, muscle paralytics, and mechanical ventilation. We aimed to determine methods for producing hypothermia in the conscious mouse by targeting two transient receptor potential channels involved in thermoregulation, two transient receptor potential (TRP) channels involved in thermoregulation, TRP vanilloid 1 (TRPV1) and TRP melastatin 8 (TRPM8). ⋯ Activating warm receptors (TRPV1) produced rapid and lasting hypothermia in young and old mice. Furthermore, hypothermia induced by TRPV1 agonists was potentiated and prolonged by simultaneous inhibition of TRPM8.