Critical care : the official journal of the Critical Care Forum
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Analyzing medical records of 979 patients with severe sepsis or septic shock provided some evidence that the use of low-dose aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) was associated with decreased hospital mortality. However, the benefit was abolished when aspirin and NSAIDs were given together.
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Observational Study
Feasibility of absolute cerebral tissue oxygen saturation during cardiopulmonary resuscitation.
Current monitoring during cardiopulmonary resuscitation (CPR) is limited to clinical observation of consciousness, breathing pattern and presence of a pulse. At the same time, the adequacy of cerebral oxygenation during CPR is critical for neurological outcome and thus survival. Cerebral oximetry, based on near-infrared spectroscopy (NIRS), provides a measure of brain oxygen saturation. Therefore, we examined the feasibility of using NIRS during CPR. ⋯ Both the FORE-SIGHT™ and EQUANOX™ technology allow non-invasive monitoring of the cerebral oxygen saturation during CPR. Moreover, changes in SctO2 values might be used to monitor the efficacy of CPR efforts.
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Several studies have shown promising results regarding the use of statins as an adjunctive treatment for sepsis. Most of those studies were retrospective or observational in nature. The ASEPSIS trial has reported that the administration of atorvastatin reduced clinical progression of sepsis but did not improve mortality. These findings are promising and further multicenter trials are needed to confirm these outcomes and to establish whether this class of medications will offer utility in this regard.
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Kashani and colleagues studied two novel markers, insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinases-2, in the urine of patients at high risk of acute kidney injury (AKI). They validated these markers in a separate large multicenter study and compared them with known markers of AKI such as neutrophil gelatinase-associated lipocalin and kidney injury molecule-1. ⋯ These markers could be useful in clinical practice to uncover silent episodes of AKI or to make an early identification of patients at risk. Ultimately they could help to detect and possibly prevent episodes of acute injury to the kidney, sometimes referred to as kidney attack.
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A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients. ⋯ Severe pain and serious adverse events are common and strongly associated while moving ICU patients for nursing procedures. Quality improvement of pain management is associated with a decrease of serious adverse events. Careful documentation of pain management during mobilization for nursing procedures could be implemented as a health quality indicator in the ICU.