Articles: critical-illness.
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Observational Study
Are serum thrombomodulin and interleukin-8 levels associated with disease severity and mortality in critically ill children with respiratory failure?
Thrombomodulin (TM) is found on endothelial cell surfaces and increases in response to endothelial injury of different organs. Interleukin (IL)-8 regulates pulmonary inflammation. TM and IL-8 are candidate biological markers of acute respiratory distress syndrome (ARDS). The aim of the present study was to compare TM and IL-8 levels in pediatric patients with and without ARDS who received respiratory support and to determine their relationships with prognosis. ⋯ In our study, higher marker levels correlated with impaired oxygenation and higher mortality. Higher TM and IL-8 levels in ARDS might reflect the degree of vascular injury and inflammation.
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In pediatric intensive care units (PICU), achieving adequate sedation for patients can be a challenging task for healthcare staff. While the use of intravenous sedatives helps improve comfort and treatment tolerance, it is a priority to develop strategies to use in patients who are difficult to sedate. This case study presents the first reported use of inhaled sevoflurane in a patient admitted to a PICU who was unresponsive to conventional intravenous sedatives. Sevoflurane was a safe and effective alternative.
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The Fluconazole pharmacokinetic-pharmacodynamic relationship was investigated in a few clinical settings and only limited studies regarding burned patients are available. Thus, the authors aimed to investigate fluconazole pharmacokinetics changes and its impact on antifungal therapy coverage against dose-dependent Candida spp. applying the PK/PD approach in critically ill severely burned patients. ⋯ Fluconazole pharmacokinetics is altered in critically ill severely burned patients, mainly related to the volume of distribution. Doses higher than usual may be necessary to reach the PK/PD target and guarantee antifungal coverage against dose-dependent Candida spp. up to MIC 32 mg/L.
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The purpose of the present study was to evaluate the potential relationship of lymphocyte-to-monocyte ratio (LMR) with outcomes of septic patients at intensive care unit (ICU) admission. ⋯ We report for the first time that a lower LMRmax value is independently predictive of a poor prognosis in septic patients. Therefore, as an inexpensive and readily available indicator, LMRmax may facilitate stratification of prognosis in septic patients.