Critical care : the official journal of the Critical Care Forum
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Comparative Study
The effect of diabetes mellitus on organ dysfunction with sepsis: an epidemiological study.
Diabetes mellitus (DM) is one of the most common chronic co-morbid medical conditions in the USA and is frequently present in patients with sepsis. Previous studies reported that people with DM and severe sepsis are less likely to develop acute lung injury (ALI). We sought to determine whether organ dysfunction differed between people with and without DM and sepsis. ⋯ In sepsis, people with diabetes are less likely to develop acute respiratory failure, irrespective of source of infection. Future studies should determine the relationship of these findings to reduced risk of ALI in people with DM and causative mechanisms.
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Comparative Study
Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers.
This study was designed to test the hypothesis of equivalence in cardiac output (CO) and stroke volume (SV) monitoring capabilities of two devices: non invasive transthoracic bioreactance (NICOM), and a pulse contour analysis (PICCO PC) coupled to transpulmonary thermodilution (PICCO TD). ⋯ Although limited to 20 patients, this study has enough power to show comparable CO and SV monitoring capabilities of Bioreactance and pulse contour analysis calibrated by transpulmonary thermodilution.
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The inflammatory response to an invading pathogen in sepsis leads to complex alterations in hemostasis by dysregulation of procoagulant and anticoagulant factors. Recent treatment options to correct these abnormalities in patients with sepsis and organ dysfunction have yielded conflicting results. Using thromboelastometry (ROTEM(R)), we assessed the course of hemostatic alterations in patients with sepsis and related these alterations to the severity of organ dysfunction. ⋯ Key variables of ROTEM(R) remained within the reference ranges during the phase of critical illness in this cohort of patients with severe sepsis and septic shock without bleeding complications. Improved organ dysfunction upon discharge from the ICU was associated with shortened coagulation time, accelerated clot formation, and increased firmness of the formed blood clot when compared with values on admission. With increased severity of illness, changes of ROTEM(R) variables were more pronounced.
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Muscle weakness is prevalent in critically ill patients and can have a dramatic effect on short- and long-term outcomes, yet there are currently no interventions with proven efficacy in preventing or treating this complication. In a new randomized trial, researchers found that serial electrical muscle stimulation significantly mitigated ultrasound-defined muscle atrophy, and the treatment was not linked to adverse effects. Although preliminary, these results, together with other recent studies, indicate a paradigm shift to a proactive approach in managing neuromuscular complications in the ICU.
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To investigate the effects of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) with normal intra-abdominal pressure (IAP < 12 mmHg) and with intra-abdominal hypertension (IAH, defined as IAP >or= 12 mmHg) during lung protective ventilation and a decremental PEEP, a prospective, observational clinical pilot study was performed. ⋯ IAH, within the limits of IAP measured in the present study, does not affect interpretation of respiratory mechanics, alveolar recruitment and hemodynamics.