Critical care : the official journal of the Critical Care Forum
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Comparative Study
Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study.
The aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score - the ICU Cancer Mortality Model (CMM) - in cancer patients requiring admission to the ICU. ⋯ None of the model scores accurately predicted outcome in the present group of critically ill cancer patients. In addition, there was no advantage of CMM over the other general models.
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Acute lung injury (ALI) and the acute respiratory distress syndrome are complex syndromes because both inflammatory and coagulation cascades cause lung injury. Transport of salt and water, repair and remodeling of the lung, apoptosis, and necrosis are additional important mechanisms of injury. Alveolar edema is cleared by active transport of salt and water from the alveoli into the lung interstitium by complex cellular mechanisms. ⋯ This update reviews specifically the evidence on the effects of beta-2 agonists in human ALI and in models of ALI. The available evidence suggests that beta-2 agonists may be efficacious therapy in ALI. Further randomized controlled trials of beta agonists in pulmonary edema and in acute lung injury are necessary.
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Of brain-injured patients admitted to intensive care units, a significant number acquires nosocomial infections. Increased susceptibility to infectious agents could, at least partly, be due to transient immunodepression triggered by brain damage. ⋯ Activation of the hypothalamo-pituitary-adrenal axis and the sympathetic nervous system plays a crucial role in brain-mediated immunodepression. In this review we discuss the role of immunodepression in the development of nosocomial infections and clinical trials on immunomodulation in brain-injured patients with hospital-acquired infections.
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Severe sepsis is a dreaded consequence of infection and necessitates intensive care treatment. Severe sepsis has a profound impact on mortality and on hospital costs, but recent incidence data from The Netherlands are not available. The purpose of the present study was to determine the prevalence and incidence of severe sepsis occurring during the first 24 hours of admission in Dutch intensive care units (ICUs). ⋯ The annual number of admissions for severe sepsis in Dutch ICUs was calculated at 8643 +/- 929 cases/year, which is 0.054% of the population, 0.61% of hospital admissions and 11% of ICU admissions.
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Most hospitals are facing the dilemma caused by demand for critical care beds outstripping supply. This imbalance is likely to get worse over the coming years as a result of many factors, including aging of the population, improved technology, and improved therapies, among other factors. ⋯ In this issue of Critical Care, two authors debate the appropriateness of providing life support in accordance with a family's wishes to an individual who is unlikely to survive admission to the intensive care unit. Understanding both sides of this debate is an important aspect of an intensivist's job.