Critical care : the official journal of the Critical Care Forum
-
Comment
Epinephrine kinetics in septic shock--a means to understand variable catecholamine efficiency?
It is well-established that the hemodynamic response to infusing catecholamines, the most frequently applied drugs for circulatory support during shock states, may vary markedly within and between individuals. In this context it is striking that only scarce data are available on the pharmacokinetics of catecholamines in critically ill patients. ⋯ Abboud and colleagues now report that, in patients with septic shock, epinephrine kinetics are linear and its clearance directly depends on body weight and is inversely related to the severity of the disease. The authors conclude that the endogenous adrenal axis hormones do not assume any additional importance.
-
ICU delirium is associated with poor patient outcome. Risk factor stratification is essential to the understanding, prevention and treatment of this disorder. Alcohol consumption, smoking and prior cognitive impairment appear strongly correlated with delirium risk. Several potentially modifiable associations deserve prospective study: these include administration of sedatives and opiates; multiple catheters; as well as minimizing physical restraints and enabling visitors.
-
The experience on management of crush injury after a devastating earthquake is lacking, and there are even less reports on the front-line critical care of these patients. A front-line intensive care unit (ICU) was set up in a tent after the disastrous Wenchuan earthquake (May, 12, 2008, China), where 32 patients suffering from crush injury were treated from May 12 to May 26. This study summarized our experience on management of 32 crush injury patients in a front-line tent ICU. ⋯ Severe crushing injuries and life-threatening complications are major causes of death after major disasters like earthquakes. Prompt treatment and close monitoring of the severe complications are of great importance in saving patients' lives. Establishment of a well-equipped front-line ICU close to the epicentre of the earthquake allows for prompt on the spot rescue of critical patients with crush injury, greatly decreasing the mortality rate and complications and avoiding amputation. There should be sufficient equipment to meet the needs of more patients.
-
Extracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Favourable effects of haemofiltration during cardiopulmonary bypass instigated the use of this technique in infants on extracorporeal membrane oxygenation. The current study aimed at comparing clinical outcomes of newborns on extracorporeal membrane oxygenation with and without continuous haemofiltration. ⋯ Adding continuous haemofiltration to the extracorporeal membrane oxygenation circuit in newborns improves outcome by significantly reducing time on extracorporeal membrane oxygenation and on mechanical ventilation, because of better fluid management and a possible reduction of capillary leakage syndrome. Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower.
-
The present study aimed to investigate changes of the immune response between sepsis due to ventilator-associated pneumonia (VAP) and sepsis due to other types of infections. ⋯ Decrease of CD4-lymphocytes and immunoparalysis of monocytes are characteristic alterations of sepsis arising in the field of VAP.