Critical care : the official journal of the Critical Care Forum
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Delirium is a common complication in the intensive care unit. The attention of researchers has shifted from the treatment to the prevention of the syndrome necessitating the study of associated risk factors. ⋯ This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness, and the environment. Particularly among those related to the acute illness and the environment, several factors are suitable for preventive action.
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Randomized Controlled Trial Comparative Study
Automatic versus manual pressure support reduction in the weaning of post-operative patients: a randomised controlled trial.
Reduction of automatic pressure support based on a target respiratory frequency or mandatory rate ventilation (MRV) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit (ICU) setting. We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients. ⋯ The duration of the automatic reduction of pressure support was similar to the manual one in the post-operative period in the ICU, but presented more complications, especially no adaptation to the MRV algorithm.
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Comment Review
Excess circulating angiopoietin-2 levels in sepsis: harbinger of death in the intensive care unit?
The early recognition and management of sepsis remain the greatest challenges in the field of critical care medicine. Endothelial injury is one of the hallmarks of sepsis, leading to capillary leak, microcirculatory dysfunction, organ failure, and eventual death in many critically ill patients. The angiogenic growth factors, angiopoietin (angpt)-1 and angpt-2, act upon the Tie-2 receptor in opposing roles. ⋯ In the study by Kümpers and colleagues in the previous issue of Critical Care, angpt-2 levels correlated with markers of tissue hypoxia, disease severity, and mortality in septic adults. However, the temporal kinetics of the angiopoietins were not assessed. It remains to be seen whether angpt-2 levels will function solely as an early marker of sepsis or whether the manipulation of the angpt/Tie-2 system will become a rational therapeutic target for the management of sepsis.
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Neurological prognostic factors after cardiopulmonary resuscitation (CPR) in patients with cardiac arrest (CA) as early and accurately as possible are urgently needed to determine therapeutic strategies after successful CPR. In particular, serum levels of protein neuron-specific enolase (NSE) and S-100B are considered promising candidates for neurological predictors, and many investigations on the clinical usefulness of these markers have been published. However, the design adopted varied from study to study, making a systematic literature review extremely difficult. The present review focuses on the following three respects for the study design: definitions of outcome, value of specificity and time points of blood sampling. ⋯ In such circumstances, the findings of the present study should aid future investigators in examining the clinical usefulness of these markers and determination of cut-off values.