Critical care : the official journal of the Critical Care Forum
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Limited data are available regarding the relationship of premortem clinical diagnoses and postmortem autopsy findings in cancer patients who die in an oncologic intensive care unit (ICU). The purposes of this study were to compare the premortem clinical and postmortem diagnoses of cancer patients who died in the ICU and to analyze any discrepancies between them. ⋯ There was a discrepancy rate of 26% between premortem clinical diagnoses and postmortem findings in cancer patients who died in a medical-surgical ICU at a tertiary care cancer center. Our findings underscore the need for enhanced surveillance, monitoring, and treatment of infections and cardiopulmonary disorders in critically ill cancer patients.
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To gain insight into factors that might affect results of future case-control studies, we performed an analysis of children with sepsis and purpura admitted to the paediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital (Rotterdam, The Netherlands). ⋯ Age and gender are determinants of severity of paediatric sepsis and purpura. Survival rates have improved during the last two decades.
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Large-tidal volume (VT) mechanical ventilation and hyperoxia used in patients with acute respiratory distress syndrome can damage pulmonary epithelial cells through lung inflammation and apoptotic cell death. Hyperoxia has been shown to increase ventilator-induced lung injury, but the mechanisms regulating interaction between large VT and hyperoxia are unclear. We hypothesized that the addition of hyperoxia to large-VT ventilation would increase neutrophil infiltration by upregulation of the cytokine macrophage inflammatory protein-2 (MIP-2) and would increase apoptosis via the mitogen-activated protein kinase pathways. ⋯ We conclude that hyperoxia increased high-VT-induced cytokine production, neutrophil influx, and apoptotic cell death through activation of the JNK and ERK1/2 pathways.
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In a recent issue of Critical Care, Mally and colleagues reported outcomes from an observational study of out-of-hospital cardiac arrests in Slovenia. Multivariable analysis identified independent predictors for hospital discharge, including higher end-tidal carbon dioxide (ETCO2) levels, higher mean arterial pressure (MAP) and the recency (years) of the arrest. ETCO2 has been previously demonstrated to correlate with cardiac index, and predict successful resuscitation. ⋯ During this period a number of factors could have contributed to the improved outcome. These include new guidelines, the awareness of the importance of good CPR (including avoidance of hyperventilation), and better post-resuscitation care (including therapeutic hypothermia). It is hard to unravel the actual contribution of these factors to the final outcome, but the authors should be commended for their excellent overall results, and their thought provoking manuscript.
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Comparative Study
Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives.
We compared the effects of mechanical ventilation with a lower tidal volume (V(T)) strategy versus those of greater V(T) in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives. ⋯ Concerns regarding sedation requirements with use of lower V(T) are unfounded and should not preclude its use in patients with ALI/ARDS.