Critical care : the official journal of the Critical Care Forum
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Central venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs. In pediatric cardiac surgery, lactate level and kinetics during and after cardiopulmonary bypass are associated with outcome variables. The aim of this study was to explore the hypothesis that the lowest central venous oxygen saturation and the peak lactate value during cardiopulmonary bypass, used alone or in combination, may be predictive of major morbidity and mortality in pediatric cardiac surgery. ⋯ The combination of a continuous monitoring of central venous oxygen saturation and serial measurements of blood lactate during cardiopulmonary bypass may offer a predictive index for major morbidity after cardiac operations in pediatric patients. This study generates the hypothesis that strategies aimed to preserve oxygen delivery during cardiopulmonary bypass may reduce the occurrence of low values of central venous oxygen saturation and elevated lactate levels. Further studies should consider this hypothesis and take into account other time-related factors, such as time of exposure to low values of central venous oxygen saturation and kinetics of lactate formation.
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Mortality is the most widely accepted outcome measure in randomized controlled trials of therapies for critically ill adults, but most of these trials fail to show a statistically significant mortality benefit. The reasons for this are unknown. ⋯ Investigators of therapies for critical illness systematically overestimate treatment effect size (delta) during the design of randomized controlled trials. This bias, which we refer to as "delta inflation", is a potential reason that these trials have a high rate of negative results."Absence of evidence is not evidence of absence."
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Sepsis-associated encephalopathy (SAE) resembles metabolic encephalopathies but with a difference: there is the potential for enduring brain damage/dysfunction. The pathogenesis of SAE is likely multifactorial. ⋯ Mild cases of SAE are often completely reversible, but there is increasing evidence that severe cases have neurological sequelae. A better understanding of the mechanisms may lead to brain-sparing, protective strategies.
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The impact of anemia on functional outcome and mortality in patients suffering from non-traumatic intracerebral hemorrhage (ICH) has not been investigated. Here, we assessed the relationship between hemoglobin (HB) levels and clinical outcome after ICH. ⋯ We report an association between low HB and poor outcome in patients with non-traumatic, supratentorial ICH. While a causal relationship could not be proven, previous experimental studies and studies in brain injured patients provide evidence for detrimental effects of anemia on brain metabolism. However, the potential risk of anemia must be balanced against the risk of harm from red blood cell infusion.
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In a recent issue of Critical Care, den Hartog and colleagues show an association between spontaneous hypothermia, defined by an admission body temperature < 35°C, and poor outcome in patients with coma after cardiac arrest (CA) treated with therapeutic hypothermia (TH). Given that TH alters neurological prognostication, studies aiming to identify early markers of injury severity and outcome are welcome, since they may contribute overall to optimize the management of comatose CA patients. This study provides an important message to clinicians involved in post-resuscitation care and raises important questions that need to be taken into account in future studies.