Critical care : the official journal of the Critical Care Forum
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Multicenter Study
Mortality in sepsis versus non-sepsis induced acute lung injury.
Sepsis-induced acute lung injury (ALI) has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding. ⋯ Greater severity of illness contributes to the higher case fatality rate observed in sepsis-induced ALI. Sepsis was not independently associated with mortality in our study.
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Multicenter Study
Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study.
Central venous oxygen saturation (ScvO2) has emerged as an important resuscitation goal for critically ill patients. Nevertheless, growing concerns about its limitations as a perfusion parameter have been expressed recently, including the uncommon finding of low ScvO2 values in patients in the intensive care unit (ICU). Emergency intubation may induce strong and eventually divergent effects on the physiologic determinants of oxygen transport (DO2) and oxygen consumption (VO2) and, thus, on ScvO2. Therefore, we conducted a study to determine the impact of emergency intubation on ScvO2. ⋯ ScvO2 increases significantly in response to emergency intubation in the majority of septic and non-septic patients. When interpreting ScvO2 during early resuscitation, it is crucial to consider whether the patient has been recently intubated or is spontaneously breathing.
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Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-term consequences. Efforts to decrease delirium prevalence have been directed at identifying and modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. ⋯ However, studies have demonstrated many similarities between the clinical and physiologic profiles of patients with delirium and sleep deprivation. This article aims to review the literature, the clinical and neurobiologic consequences of sleep deprivation, and the potential relationship between sleep deprivation and delirium in intensive care unit patients. Sleep deprivation may prove to be a modifiable risk factor for the development of delirium with important implications for the acute and long-term outcome of critically ill patients.
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Comparative Study
Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome?
The study objectives were to evaluate septic shock-induced alterations in skeletal muscle hemoglobin oxygenation saturation (StO2) using near-infrared spectroscopy (NIRS) and forearm skin blood flow velocity using laser Doppler (LD) to determine the relationship of macroperfusion and microperfusion parameters, and to test the relationship of the worst NIRS parameters during the first 24 hours of shock with 28-day prognosis. ⋯ The alteration of StO2 reperfusion slope in septic shock patients compared with healthy volunteers was related with macrohemodynamic, microhemodynamic and metabolic parameters. The addition of the worst value of the day 1 StO2 reperfusion slope improved the outcome prediction of Simplified Acute Physiology Score II and SOFA scores.
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Early identification of haemodynamic shock is widely acknowledged as a vital step towards improving survival. A report in the previous issue of Critical Care describes the relationship between lactate concentrations in blood samples analysed in the prehospital environment and subsequent hospital mortality. These preliminary data indicate a promising avenue of research into the treatment of haemodynamic shock. Larger observational and interventional trials are needed to confirm the clinical value of serum lactate measurement in the prehospital environment.