Critical care medicine
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Critical care medicine · Jul 2014
Multicenter StudyAssociation Between the Choice of IV Crystalloid and In-Hospital Mortality Among Critically Ill Adults With Sepsis.
Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. ⋯ Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If confirmed in randomized trials, this finding could have significant public health implications, as crystalloid resuscitation is nearly universal in sepsis.
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Critical care medicine · Jul 2014
The Impact of Variation in Renal Replacement Therapy Settings on Piperacillin, Meropenem, and Vancomycin Drug Clearance in the Critically Ill: An Analysis of Published Literature and Dosing Regimens.
To describe the effect of different renal replacement therapy modalities and settings on the clearance of meropenem, piperacillin, and vancomycin in critically ill patients and to evaluate the frequency with which current dosing regimens achieve therapeutic concentrations. ⋯ Effluent flow rate appears to be a reliable predictor of antibiotic clearance in critically ill patients despite significantly altered pharmacokinetics in these patients. Higher dosing regimens maybe required in critically ill patients receiving renal replacement therapy, in the presence of high effluent flow rates and/or the presence of poorly susceptible pathogens, particularly for vancomycin.
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Critical care medicine · Jul 2014
Muscle-Specific Inhibition of the Classical Nuclear Factor-κB Pathway Is Protective Against Diaphragmatic Weakness in Murine Endotoxemia.
Diaphragmatic weakness and acute respiratory failure are common in sepsis. Nuclear factor-κB acts as a general coordinator of the systemic inflammatory response, but its role within the diaphragm itself during sepsis is unknown. We investigated the potential protective effect upon the diaphragm of inhibiting nuclear factor-κB only within muscle fibers during acute endotoxemia. ⋯ These results suggest that nuclear factor-κB signaling within skeletal muscle fibers is a key pathway leading to diaphragmatic weakness during acute endotoxemia, most likely via effects on multiple inflammatory mediators. In addition, inhibition of nuclear factor-κB signaling within diaphragm muscle fibers has complex effects on caspase-3 activation, which could have implications for the treatment of sepsis-induced diaphragmatic dysfunction.