Critical care : the official journal of the Critical Care Forum
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Multicenter Study
The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients.
To estimate the mortality and length of stay in the intensive care unit (ICU) attributable to clinically important gastrointestinal bleeding in mechanically ventilated critically ill patients. ⋯ Clinically important upper gastrointestinal bleeding has an important attributable morbidity and mortality, associated with a RR of death of 1-4 and an excess length of ICU stay of approximately 4-8 days.
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This commentary on the World Trade Center attack is written from the perspective of a New York City critical care service, with a long history of activity in disaster management, which is located at the Montefiore Medical Center/Albert Einstein College of Medicine. The paper describes some of the local concerns of the service in the first hours, the reality of dispersal of victims throughout the New York City hospital system, and some of the resources made available and their utilization. ⋯ A large capacity is subsequently in place to provide care to critically ill patients resulting from manmade as well as natural disasters. It was the nature of the World Trade Center attack in terms of the ratio of injured survivors to dead victims that did not allow the full capacity and capability of the system to engage.
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Advances in organization and patient management in the intensive care unit (ICU) have led to reductions in the morbidity and mortality suffered by critically ill patients. Two such advances include multidisciplinary teams (MDTs) and the development of clinical protocols. The use of protocols and MDTs does not necessarily guarantee instant improvement in the quality of care, but it does offer useful tools for the pursuit of such objectives. As ICU physicians increasingly assume leadership roles in the pursuit of higher quality ICU care, their knowledge and skills in the discipline of quality improvement will become essential.
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It is known that proinflammatory and anti-inflammatory cytokines are released during and after cardiopulmonary bypass (CPB) in infants and children. Sex steroids are known to have immunomodulatory functions, and release of the anti-inflammatory cytokine IL-10 is stimulated by progesterone in vitro. The purpose of the present study was to investigate the plasma levels of progesterone, IL-8 (proinflammatory cytokine) and IL-10, and to relate them to sex and postoperative morbidity. ⋯ The present study shows that CPB induces a significant and marked increase in plasma levels of progesterone in infants and children. Studies of administration of progesterone-blocking substances to male and female animals may help to elucidate the roles of sex and progesterone in the setting of CBP.
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The European Society of Intensive Care Medicine Annual Congress offers the opportunity for basic scientists and clinicians to share recent findings. Apart from the large number of free communications, several sessions of the congress were dedicated to state-of-the-art tutorials given by established speakers. ⋯ The benefits of several new compounds observed experimentally need to be confirmed clinically. The European Society of Intensive Care Medicine Congress is well established as a unique opportunity to implement and to promote a collaboration between European basic scientists and clinicians.