Critical care : the official journal of the Critical Care Forum
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Fluid resuscitation is a cornerstone of intensive care unit patient care, but prediction of the cardiovascular response remains difficult, despite many efforts in clinical research. The concept of responders and nonresponders illustrates such a difficulty. Many techniques have been tested, from strictly non-invasive to invasive, delivering various parameters related to the fluid challenge response. ⋯ This published study tested in the postoperative period of cardiovascular surgery the prediction obtained with filling pressures and the diastolic volume. When left ventricular function (global ejection fraction) is adequate, the volume before fluid administration seems to predict well the fluid challenge response; whereas when the global ejection fraction is poor, the filling pressure seems more suitable. The present commentary discusses the main physiological issues related to these findings, with some methodological aspects.
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Editorial Comment
Finding new therapies for sepsis: the need for patient stratification and the use of genetic biomarkers.
Reversing the immunoparalysis associated with septic shock remains a priority for improving the outcome of patients suffering from sepsis. The efficacy of future therapies may be better studied under an effective system of patient stratification. Gene expression biomarkers offer a mechanism by which patients may be appropriately stratified in such clinical trials.
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The purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa. ⋯ Specific interaction between both patient colonization pressure and selective antibiotic pressure is the most relevant factor for P. aeruginosa acquisition on an ICU. This suggests that combined efforts are needed against both factors to decrease colonization with P. aeruginosa.
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Virus-associated hemophagocytic syndrome (VAHS) is a severe complication of various viral infections often resulting in multiorgan failure and death. The purpose of this study was to describe baseline characteristics, development of VAHS, related treatments and associated mortality rate of consecutive critically ill patients with confirmed 2009 influenza A (H1N1) infection and respiratory failure. ⋯ The findings of this study raise the possibility that VAHS may be a frequent complication of severe 2009 influenza A (H1N1) infection and represents an important contributor to multiorgan failure and death.
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Previous studies have documented a high frequency of endotoxemia associated with cardiopulmonary bypass (CPB). Endotoxemia may be responsible for some of the complications associated with cardiac surgery. The purpose of the study was to examine the prevalence of endotoxemia during cardiopulmonary bypass supported aortocoronary bypass grafting surgery (ACB) using a new assay, the Endotoxin Activity Assay (EAA), and explore the association between endotoxemia and post-operative infection. ⋯ High levels of endotoxin occur less frequently during ACB than previously documented. However, endotoxemia is associated with a significantly increased risk of the development of post-operative infection. Measuring endotoxin levels during ACB may provide a mechanism to identify and target a high risk patient population.