Critical care medicine
-
Critical care medicine · Sep 2018
Meta AnalysisCorticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis.
This systematic review and meta-analysis addresses the efficacy and safety of corticosteroids in critically ill patients with sepsis. ⋯ In critically ill patients with sepsis, corticosteroids possibly result in a small reduction in mortality while also possibly increasing the risk of neuromuscular weakness.
-
Critical care medicine · Sep 2018
Randomized Controlled TrialExploratory Application of Neuropharmacometabolomics in Severe Childhood Traumatic Brain Injury.
To employ metabolomics-based pathway and network analyses to evaluate the cerebrospinal fluid metabolome after severe traumatic brain injury in children and the capacity of combination therapy with probenecid and N-acetylcysteine to impact glutathione-related and other pathways and networks, relative to placebo treatment. ⋯ This proof-of-concept neuropharmacometabolomics assessment reveals alterations in known and previously unidentified metabolic pathways and supports therapeutic target engagement of the combination of probenecid and N-acetylcysteine treatment after severe traumatic brain injury in children.
-
Critical care medicine · Sep 2018
Comparative Study Observational StudyAdenosine Plasma Level and A2A Receptor Expression in Patients With Cardiogenic Shock.
To investigate whether adenosine A2A receptors lead to vasodilation and positive inotropic function under stimulation and whether they play a role in the control of blood pressure in patients with cardiogenic shock. ⋯ We observed high adenosine plasma level and low A2A receptor expression at admission in patients with cardiogenic shock versus acute heart failure or acute myocardial infarction. This may contribute to the physiopathology of cardiogenic shock.
-
Critical care medicine · Sep 2018
ReviewManagement of the Critically Ill Adult Chimeric Antigen Receptor-T Cell Therapy Patient: A Critical Care Perspective.
Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. ⋯ Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.
-
Critical care medicine · Sep 2018
Randomized Controlled TrialImpact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial.
As the catabolic state induced by septic shock together with the physical inactivity of patients lead to the rapid loss of muscle mass and impaired function, the purpose of this study was to test whether an early physical therapy during the onset of septic shock regulates catabolic signals and preserves skeletal muscle mass. ⋯ Early physical therapy during the first week of septic shock is safe and preserves muscle fiber cross-sectional area.