Critical care : the official journal of the Critical Care Forum
-
During 2009, Critical Care published nine papers on various aspects of resuscitation, prehospital medicine, trauma care and disaster response. One article demonstrated that children as young as 9 years of age can learn cardiopulmonary resuscitation (CPR) effectively, although, depending on their size, some may have difficulty performing it. Another paper showed that while there was a trend toward mild therapeutic hypothermia reducing S-100 levels, there was no statistically significant change. ⋯ One other study, conducted in the prehospital environment, found that end-tidal CO2 could be useful in diagnosing pulmonary embolism. Three articles addressed disaster medicine, the first of which described a triage system for use during pandemic influenza that demonstrated high reliability in delineating patients with a good chance of survival from those likely to die. The other two studies, both drawn from the 2008 Sichuan earthquake experience, showed success in treating crush injured patients in an on-site tent ICU and, in the second case, how the epidemiology of earthquake injuries and related factors predicted mortality.
-
Hyperglycemia and insulin resistance are well-known features of critical illness and impact the mortality rate, especially in sepsis. Retinol binding protein 4 (RBP4) promotes insulin resistance in mice and is systemically elevated in patients with obesity and type 2 diabetes. We investigated the potential role of RBP4 in critically ill patients. ⋯ Serum RBP4 concentrations are significantly reduced in critically ill patients. The strong associations with hepatic and renal function, insulin resistance and acute mortality collectively suggest a role of RBP4 in the pathogenesis of critical illness, possibly as a negative acute phase reactant, and allow a proposition as a potential novel biomarker for ICU patients.
-
Multicenter Study
Insulin-treated diabetes is not associated with increased mortality in critically ill patients.
This was a planned substudy from the European observational Sepsis Occurrence in Acutely ill Patients (SOAP) study to investigate the possible impact of insulin-treated diabetes on morbidity and mortality in ICU patients. ⋯ Even though patients with a history of insulin-treated diabetes are more severely ill and more likely to have renal failure, insulin-treated diabetes is not associated with increased mortality in ICU patients.
-
We summarize original research in the field of critical care nephrology accepted or published in 2009 in Critical Care or, when considered relevant or directly linked to this research, in other journals. Four main topics have been identified for a rapid overview: (a) post-surgical acute kidney injury (AKI); (b) timing of renal replacement therapy (RRT): different authors examined this critical issue of RRT in different settings (post-surgical patients, burned patients, and intensive care unit patients); (c) DoReMi (Dose Response Multicentre International) and other important surveys on dialysis dose and management; and (d) pediatric AKI and RRT: interest in this last topic is increasing, and studies on biomarkers, complications of pediatric dialysis, and application of RRT to extracorporeal membrane oxygenation are discussed.
-
Comparative Study
Copeptin and risk stratification in patients with acute dyspnea.
The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of Copeptin, the C-terminal part of the vasopressin prohormone alone and combined to N-terminal pro B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea. ⋯ Copeptin is a new promising prognostic marker for short-term mortality independently and additive to natriuretic peptide levels in patients with acute dyspnea.