Critical care medicine
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Critical care medicine · Nov 2015
Randomized Controlled Trial Comparative StudyA Randomized Study of a Single Dose of Intramuscular Cholecalciferol in Critically Ill Adults.
To determine the effect of two doses of intramuscular cholecalciferol on serial serum 25-hydroxy-vitamin-D levels and on pharmacodynamics endpoints: calcium, phosphate, parathyroid hormone, C-reactive protein, interleukin-6, and cathelicidin in critically ill adults. ⋯ A single dose of either dose of intramuscular cholecalciferol corrected vitamin D deficiency in the majority of critically ill patients. Greater vitamin D increments were associated with early greater cathelicidin increases, suggesting a possible mechanism of vitamin D supplementation in inducing bactericidal pleiotropic effects.
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Critical care medicine · Nov 2015
Multicenter StudyAcutely Bereaved Surrogates' Stories About the Decision to Limit Life Support in the ICU.
Participating in a decision to limit life support for a loved one in the ICU is associated with adverse mental health consequences for surrogate decision makers. We sought to describe acutely bereaved surrogates' experiences surrounding this decision. ⋯ In this all-white sample of surrogates with nonpassive decision control preferences from a single US region, participating in decision making allowed surrogates to regain control, counteract feelings of helplessness, and end their empathic suffering. Although previous research highlighted the distress caused by participation in a decision to limit life support, the act of decision making may, counterintuitively, help some surrogates cope with the experience.
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Critical care medicine · Nov 2015
Higher Dead Space Is Associated With Increased Mortality in Critically Ill Children.
Elevated dead space has been consistently associated with increased mortality in adults with respiratory failure. In children, the evidence for this association is more limited. We sought to investigate the association between dead space and mortality in mechanically ventilated children. ⋯ Increased dead space is associated with higher mortality in critically ill children, although it is no longer independently associated with mortality after controlling for severity of oxygenation defect, inotrope use, and severity of illness. However, because end-tidal alveolar dead space fraction is easy to calculate at the bedside, it may be useful for risk stratification and severity-of-illness scores.
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Critical care medicine · Nov 2015
Comparative Study Observational StudyThe Involvement of Danger-Associated Molecular Patterns in the Development of Immunoparalysis in Cardiac Arrest Patients.
After cardiac arrest, patients are highly vulnerable toward infections, possibly due to a suppressed state of the immune system called "immunoparalysis." We investigated if immunoparalysis develops following cardiac arrest and whether the release of danger-associated molecular patterns could be involved. ⋯ Release of danger-associated molecular patterns during the first days after cardiac arrest is associated with the development of immunoparalysis. This could explain the increased susceptibility toward infections in cardiac arrest patients.
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Critical care medicine · Nov 2015
Comparative StudyKinin B1 Receptor Antagonist BI113823 Reduces Acute Lung Injury.
This study was undertaken to examine the effects of BI113823, a potent small molecule orally active nonpeptide B1 receptor antagonist, in an experimental model of endotoxin-induced direct lung injury in mice and indirect lung injury and survival in cecal ligation and puncture-induced polymicrobial sepsis in rats. ⋯ Administration of B1 receptor antagonist BI113823 significantly reduced endotoxin-induced direct lung injury and also reduced sepsis-induced lung inflammatory response. Most importantly, BI113823 improved survival following severe polymicrobial sepsis.