Critical care : the official journal of the Critical Care Forum
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Cross-talk between the coagulation system and inflammatory reactions during sepsis causes organ damage followed by multiple organ dysfunction syndrome or even death. Therefore, anticoagulant therapies have been expected to be beneficial in the treatment of severe sepsis. Recombinant human soluble thrombomodulin (rhTM) binds to thrombin to inactivate coagulation, and the thrombin-rhTM complex activates protein C to produce activated protein C. The purpose of this study was to examine the efficacy of rhTM for treating patients with sepsis-induced disseminated intravascular coagulation (DIC). ⋯ We found that rhTM administration may improve organ dysfunction in patients with sepsis-induced DIC. Further clinical investigations are necessary to evaluate the effect of rhTM on the pathophysiology of sepsis-induced DIC.
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Experiencing treatment on a modern intensive care unit (ICU) is a potentially traumatic event. People who experience traumatic events have an increased risk of depression, anxiety disorders and post-traumatic stress disorder (PTSD). ⋯ The extent to which the consequences of critical illness and the treatments received in the ICU contribute to the development of PTSD is poorly understood and more rigorous studies are needed. Understanding the factors associated with a poor psychological recovery after critical illness is essential to generate models of causality and prognosis, and to guide the delivery of effective, timely interventions.
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Computed tomography of the lung has shown that ventilation shifts from dependent to nondependent lung regions. In this study, we investigated whether, at the bedside, electrical impedance tomography (EIT) at the cranial and caudal thoracic levels can be used to visualize changes in ventilation distribution during a decremental positive end-expiratory pressure (PEEP) trial and the relation of these changes to global compliance in mechanically ventilated patients. ⋯ At the bedside, EIT measured at two thoracic levels showed different behavior between the caudal and cranial lung levels during a decremental PEEP trial. These results indicate that there is probably no single optimal PEEP level for all lung regions.
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Blood pressure saggy? Cardiac output low? Oliguria? Increasing acidosis? Peripheries a bit cool? Poor cardiac history? No problem. Just start some dobutamine and watch the numbers improve. ⋯ Or is it? Catecholamines are long-established drugs that have never undergone formal testing of long-term outcomes and safety. Their use requires re-evaluation in the light of a wide range of deleterious actions and retrospective studies suggesting harm.
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Nearly a decade since the introduction of therapeutic hypothermia to the ICU for cooling out-of-hospital cardiac arrest patients, key questions remain unanswered: when should cooling be initiated, how rapidly should the patient be cooled and using which device? The Time to Target Temperature study group provides important baseline data on the striking direct relationship between body temperature and survival from out-of-hospital cardiac arrest.