Critical care medicine
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Critical care medicine · Feb 2016
Randomized Controlled Trial Multicenter StudyRandomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study.
To determine if intravenous thiamine would reduce lactate in patients with septic shock. ⋯ Administration of thiamine did not improve lactate levels or other outcomes in the overall group of patients with septic shock and elevated lactate. In those with baseline thiamine deficiency, patients in the thiamine group had significantly lower lactate levels at 24 hours and a possible decrease in mortality over time.
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Critical care medicine · Feb 2016
Clinical TrialRecruitment Maneuvers and Positive End-Expiratory Pressure Titration in Morbidly Obese ICU Patients.
The approach to applying positive end-expiratory pressure in morbidly obese patients is not well defined. These patients frequently require prolonged mechanical ventilation, increasing the risk for failed liberation from ventilatory support. We hypothesized that lung recruitment maneuvers and titration of positive end-expiratory pressure were both necessary to improve lung volumes and the elastic properties of the lungs, leading to improved gas exchange. ⋯ Commonly used positive end-expiratory pressure by clinicians is inadequate for optimal mechanical ventilation of morbidly obese patients. A recruitment maneuver followed by end-expiratory pressure titration was found to significantly improve lung volumes, respiratory system elastance, and oxygenation.
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Critical care medicine · Feb 2016
Multicenter StudyA Severe Sepsis Mortality Prediction Model and Score for Use With Administrative Data.
Administrative data are used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score. ⋯ Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data.
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Critical care medicine · Feb 2016
Nebulized Epinephrine Limits Pulmonary Vascular Hyperpermeability to Water and Protein in Ovine With Burn and Smoke Inhalation Injury.
To test the hypothesis that nebulized epinephrine ameliorates pulmonary dysfunction by dual action-bronchodilation (β2-adrenergic receptor agonism) and attenuation of airway hyperemia (α1-adrenergic receptor agonism) with minimal systemic effects. ⋯ Nebulized epinephrine should be considered for use in future clinical studies of patients with burns and smoke inhalation injury.
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Although obesity is associated with risk for chronic kidney disease and improved survival, less is known about the associations of obesity with risk of acute kidney injury and post acute kidney injury mortality. ⋯ Obesity is a risk factor for acute kidney injury, which is associated with increased short- and long-term mortality.