Critical care : the official journal of the Critical Care Forum
-
Observational Study
Etiologies, diagnostic strategies and outcomes of diffuse pulmonary infiltrates causing acute respiratory failure in cancer patients: a retrospective observational study.
Although previous studies have reported etiologies, diagnostic strategies, and outcomes of acute respiratory failure (ARF) in cancer patients, few studies investigated ARF in cancer patients presenting with diffuse pulmonary infiltrates. ⋯ Invasive diagnostic tests, including lung biopsy, increased diagnostic yield and caused therapeutic modification that was significantly associated with better outcomes for diffuse pulmonary infiltrates causing ARF in cancer patients.
-
Promising preclinical results have been obtained with blood purification therapies as adjuvant treatment for sepsis. However, the mechanisms by which these therapies exert beneficial effects remain unclear. Some investigators have suggested that removal of activated leukocytes from the circulation might help ameliorate remote organ injury. We designed an extracorporeal hemoadsorption device capable of capturing both cytokines and leukocytes in order to test the hypothesis that leukocyte capture would alter circulating cytokine profiles and influence immunological cell-cell interactions in whole blood taken from patients with sepsis. ⋯ Monocyte and neutrophil capture using a sorbent polymer results in upregulation of IL-8 and modulation of cell-mediated immunity. Further studies are needed to understand better these cellular interactions in order to help design better blood purification therapies.
-
Antiplatelet therapy for the treatment of cardiovascular diseases is common in the ageing population. Whether this therapy exacerbates brain injury after head trauma is an important, but unsettled, topic. In this issue of Critical Care, Fabbri and colleagues address the question of whether pre-injury intake of antiplatelet medication increases the risk profile of patients with posttraumatic intracranial lesions after head trauma. ⋯ Since its introduction as an analgesic in 1897, aspirin has surprised the medical community more than once due to its versatile properties. Prevention of secondary brain damage through aspirin has been reported for ischaemic stroke and subarachnoid haemorrhage. In cases of acute traumatic haemorrhage after head injury, antiplatelet therapy's neuroprotective effects may be outweighed by the increased bleeding tendency.
-
Observational Study
Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type.
The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. ⋯ SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age>30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous.