Critical care : the official journal of the Critical Care Forum
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Patients with sepsis often demonstrate severely impaired immune responses. The hallmark of this state of immunoparalysis is monocytic deactivation characterized by decreased human leukocyte antigen (HLA)-DR expression and reduced production of proinflammatory cytokines. Recently, diminished numbers of dendritic cells (DCs) were reported in patients with sepsis. However, little is known about DC phenotype and function in human sepsis. We therefore compared phenotypic and functional changes in monocyte and DC subsets in patients with sepsis and immunoparalysis. ⋯ In sepsis, long-lasting functional deactivation is common to all circulating monocyte and DC subsets. In addition to decreased peripheral blood DC counts, functional impairment of antigen-presenting cells may contribute to an impaired antimicrobial defense in sepsis.
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The aim of this observational study was to investigate the prevalence of endotoxemia after surgery and its association with ICU length of stay. ⋯ 17% of our patients were characterized by high levels of endotoxemia as assessed by EA assay, despite their low level of complexity on admission. High levels of endotoxin were associated with a longer ICU length of stay.
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This study aimed to examine the long-term outcome for patients with end-stage renal failure (ESRF) who survived multiple-organ failure. ⋯ ESRF patients with multiple-organ failure have a high mortality, with the increased risk of death continuing into the early post-ICU period. Those with non-surgical diagnoses have the highest risk. Survival within the group who live beyond the early post-ICU period appears similar to the background population of ESRF patients.
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Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer, less invasive techniques. For these purposes, the transpulmonary thermodilution technique allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. ⋯ The results add to a growing body of evidence that the PAC adds little to information attainable by less invasive methods in many conditions, including acute heart failure. Whether newer devices improve outcome needs to be tested in well-controlled prospective trials.
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The present study was performed to test a new software version of the FloTrac/Vigileo using head-up-head-down tilting in post-cardiac surgery patients. Impressive improvements in Bland and Altman limits of agreement from 37.5% to 21.6% were recorded. The results, however could be attributed to a failure to produce a wide enough range of test circulatory conditions. A more rigorous test of performance is needed before any real conclusion concerning use of the FloTrac/Vigileo in clinical practice can be made.