Critical care : the official journal of the Critical Care Forum
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Review Historical Article
Bench-to-bedside review: human subjects research--are more standards needed?
There are many controversial issues surrounding ethics in study design and conduct of human subjects research. In this review we briefly touch on the origin of ethics in clinical research and how the current regulations and standards came into practice. ⋯ We address this question by reviewing and commenting on relevant literature. We conclude that what is needed are not more standards per se, but rather refinement and uniformity of current standards, and their interpretation and application both to protect human subjects and to advance medicine.
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Comparative Study
Early postoperative serum S100 beta levels predict ongoing brain damage after meningioma surgery: a prospective observational study.
Elevated serum levels of S100beta, an astrocyte-derived protein, correlate with unfavourable neurological outcomes following cardiac surgery, neurotrauma, and resuscitation. This study evaluated whether pre-/postoperative serum S100beta levels correlate with unfavourable clinical and radiological findings in patients undergoing elective meningioma resection. ⋯ In patients with meningioma, serum S100beta levels perform poorly as an indicator of tumour characteristics but may suggest ongoing postcraniotomy injury. Serum S100beta levels may serve as a potentially useful early marker of postcraniotomy brain damage in patients undergoing elective meningioma resection.
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Apoptosis of neutrophils (polymorphonuclear neutrophils [PMNs]) may limit inflammatory injury in sepsis and acute respiratory distress syndrome (ARDS), but the relationship between the severity of sepsis and extent of PMN apoptosis and the effect of superimposed ARDS is unknown. The objective of this study was to correlate neutrophil apoptosis with the severity of sepsis and sepsis-induced ARDS. ⋯ In medical patients with sepsis, neutrophil apoptosis is inversely proportional to the severity of sepsis and thus may be a marker of the severity of sepsis in this population.
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Adrenal failure (AF) is associated with increased mortality in septic patients. Nonetheless, there is no agreement regarding the best diagnostic criteria for AF. We compared the diagnosis of AF considering different baseline total cortisol cutoff values and Deltamax values after low (1 microg) and high (249 microg) doses of corticotropin, we analyzed the impact of serum albumin on AF identification and we correlated laboratorial AF with norepinephrine removal. ⋯ AF was identified in 22.5% of the studied population. Since Deltamax249 < or = 9 microg/dl results were not affected by serum albumin and since the baseline serum total cortisol varied directly with albumin levels, we propose that Deltamax249 < or = 9 microg/dl, which means Deltamax after high corticotropin dose may be a better option for AF diagnosis whenever measurement of free cortisol is not available. Baseline cortisol < or =23.6 microg/dl was the best value for predicting norepinephrine removal in patients without corticosteroid treatment.
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Comparative Study
The incidence and outcome of septic shock patients in the absence of early-goal directed therapy.
The purpose of the present study was to measure the incidence and outcome of septic patients presenting at the emergency department (ED) with criteria for early goal-directed therapy (EGDT). ⋯ In an Australian teaching hospital candidates for EGDT were uncommon and, in the absence of an EGDT protocol, their mortality was lower than that reported with EGDT.