PubMed Central (PMC3 - NLM DTD)
(2,081,148 recursos)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
Mostrando recursos 101 - 120 de 3,189
101.
The value of monitoring outcomes should be measured by the appropriateness of the response - Hofer, Timothy P
Real-time monitoring of outcomes is becoming increasingly feasible in health care, and with it the hope of early detection of problems and the ability to tell whether interventions are having their desired effect. The next step should be to try to demonstrate that the reports of such monitoring systems lead to reasonable responses and valid inferences about causality, and that we are not chasing red herrings.
102.
Strong ion difference in urine: new perspectives in acid-base assessment - Gattinoni, Luciano; Carlesso, Eleonora; Cadringher, Paolo; Caironi, Pietro
The plasmatic strong ion difference (SID) is the difference between positively and negatively charged strong ions. At pH 7.4, temperature 37°C and partial carbon dioxide tension 40 mmHg, the ideal value of SID is 42 mEq/l. The buffer base is the sum of negatively charged weak acids ([HCO3-], [A-], [H2PO4-]) and its normal value is 42 mEq/l. According to the law of electroneutrality, the amount of positive and negative charges must be equal, and therefore the SID value is equal to the buffer base value. The easiest assessment of metabolic acidosis/alkalosis relies on the base excess calculation: buffer baseactual -...
103.
Rapid molecular detection of methicillin-resistant Staphylococcus aureus: a cost-effective tool for infection control in critical care? - Struelens, Marc J; Denis, Olivier
Control strategies for methicillin-resistant Staphylococcus aureus (MRSA) in critical care remain debated. Timely detection of MRSA carriers is crucial to an effective isolation policy. In this issue, Harbarth and colleagues report rapid MRSA screening among intensive care unit-admitted patients using a PCR assay. Preemptive isolation for all admissions until screened negative for MRSA was associated with a reduction of intensive care unit-acquired MRSA infections in one of two study units. The data provide preliminary evidence to the effectiveness of a MRSA control strategy combining rapid screening by a molecular method and preventive isolation. Further controlled studies are needed to evaluate...
104.
Meningococcal disease: identifying high-risk cases - Inwald, David; Peters, Mark
In the previous issue of Critical Care, Vermont and colleagues presented a simple but well-executed observational study describing the levels of chemokines in the serum of 58 children with meningococcal sepsis. The chemokine levels correlated with disease severity and outcome. Significant correlations were demonstrated between admission chemokine levels and the Paediatric Risk of Mortality score, the Disseminated Intravascular Coagulopathy score, the Sequential Organ Failure Assessment score and laboratory parameters of disease severity. Additionally, nonsurvivors had much higher levels of chemokines compared with survivors, and the chemokine levels predicted mortality with a high degree of sensitivity and specificity. The findings are...
105.
Pro-Con Debate: Steroid use in ACTH non-responsive septic shock patients with high baseline cortisol levels - Annane, Djillali; Fan, Eddy; Herridge, Margaret S
Steroid use in critically ill, vasopressor-dependant, septic patients has gained increased acceptance in recent years with the publication of encouraging data. However, with renewed interest and/or attention comes increased debate and analysis. As a result, it is not surprising to find that there is still significant controversy with regards to the role of steroids in many patients. In this article, two expert groups debate the role of steroid use in a septic shock patient with arguably no clear evidence of adrenal insufficiency.
107.
A validated clinical approach for the management of aspergillosis in critically ill patients: ready, steady, go! - Garnacho-Montero, Jose; Amaya-Villar, Rosario
The clinical relevance of recovering Aspergillus species in intensive care unit patients is unknown. Diagnosis of invasive pulmonary aspergillosis is extremely difficult because there are no specific tests sensitive enough to detect it. The rapidly fatal prognosis of this infection without treatment justifies early antifungal therapy. A clinical algorithm may aid clinicians to manage critically ill patients from whose respiratory specimens Aspergillus spp. have been isolated. This new tool needs to be validated in a large cohort of patients before it can be recommended.
108.
Recently published papers: Sugar, soap and statins an unlikely recipe for the critically ill - Bacon, David; Forni, Lui G
The eagerly awaited SOAP (Sepsis Occurrence in Acutely ill Patients) study is published and its observational data provide much of interest, not least in generating further hypotheses on improving treatment in this challenging group. Glycaemic control in the critically ill is once more the focus of attention, and we discuss three studies in this area. Not least among these reports is that from the van den Bergh group, who provide further data on their intensive insulin protocol in a more heterogeneous group, namely medical intensive care unit patients. Finally, we discuss another good reason to take statins.
109.
The choice of catecholamines in septic shock: more and more good arguments to strengthen the known position, but don't lose the faith! - Meier-Hellmann, Andreas
The choice of catecholamines for hemodynamic stabilisation in septic shock patients has been an ongoing debate for several years. Several studies have investigated the regional effects in septic patients. Because of an often very small sample size, because of inconsistent results and because of methodical problems in the monitoring techniques used in these studies, however, it is not possible to provide clear recommendations concerning the use of catecholamines in sepsis. Prospective and adequate-sized studies are necessary because outcome data are completely lacking.
111.
Year in review 2005: Critical Care resource management - Amaral, André Carlos Kajdacsy-Balla; Rubenfeld, Gordon D
During 2005 Critical Care published several original papers dealing with resource management. Emphasis was placed on sepsis, especially the coagulation cascade, prognosis and resuscitation. The papers highlighted important aspects of the pathophysiology of coagulation and inflammation in sepsis, as well as dealing with the proper use of newly developed compounds. Several aspects of prognosis in critically ill patients were investigated, focusing on biological markers and clinical indexes. Resuscitation received great attention, dealing with the effects of fluid infusion in hemodynamics and the lung. The information obtained can be used to address unknown effects of established therapies, to enlighten current clinical...
112.
Pro/Con Debate: Does recombinant factor VIIa have a role to play in the treatment of patients with acute nontraumatic hemorrhage? - Pieri, Paola; Stein, Deborah M; Scarpelini, Sandro; Rizoli, Sandro
Perhaps it is not surprising that in the critical care environment, where lives are frequently on the line, off-label use of certain drugs is relatively common. In general, there are two camps of opinion on this type of utilization. One camp would suggest that potentially life saving products cannot ethically be withheld from patients who may benefit. The other camp would counter that it is inappropriate to administer products if the risk/benefit ratio has not been clearly defined in clinical trials. Off-label use of factor VII is debated in this issue of Critical Care for a patient with uncontrolled nontraumatic...
113.
Bench-to-bedside review: Hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers - Lheureux, Philippe ER; Zahir, Soheil; Gris, Mireille; Derrey, Anne-Sophie; Penaloza, Andrea
Hyperinsulinaemia/euglycaemia therapy (HIET) consists of the infusion of high-dose regular insulin (usually 0.5 to 1 IU/kg per hour) combined with glucose to maintain euglycaemia. HIET has been proposed as an adjunctive approach in the management of overdose of calcium-channel blockers (CCBs). Indeed, experimental data and clinical experience, although limited, suggest that it could be superior to conventional pharmacological treatments including calcium salts, adrenaline (epinephrine) or glucagon. This paper reviews the patho-physiological principles underlying HIET. Insulin administration seems to allow the switch of the cell metabolism from fatty acids to carbohydrates that is required in stress conditions, especially in the myocardium...
114.
Clinical review: Thyroid hormone replacement in children after cardiac surgery is it worth a try? - Haas, Nikolaus A; Camphausen, Christoph K; Kececioglu, Deniz
Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory response, resulting in increased postoperative morbidity and mortality. Under these circumstances, a typical pattern of thyroid abnormalities is seen in the absence of primary disease, defined as sick euthyroid syndrome (SES). The presence of postoperative SES mainly in small children and neonates exposed to long bypass times and the pharmacological profile of thyroid hormones and their effects on the cardiovascular physiology make supplementation therapy an attractive treatment option to improve postoperative morbidity and mortality. Many studies have been performed with conflicting results. In this article, we review the important literature...
115.
Hyperglycaemia in critically ill patients: marker or mediator of mortality? - Corstjens, Anouk M; van der Horst, Iwan CC; Zijlstra, Jan G; Groeneveld, AB Johan; Zijlstra, Felix; Tulleken, Jaap E; Ligtenberg, Jack JM
Acute hyperglycaemia has been associated with complications, prolonged intensive care unit and hospital stay, and increased mortality. We made an inventory of the prevalence and prognostic value of hyperglycaemia, and of the effects of glucose control in different groups of critically ill patients. The prevalence of hyperglycaemia in critically ill patients, using stringent criteria, approaches 100%. An unambiguous negative correlation between hyperglycaemia and mortality has been described in various groups of critically ill patients. Although the available evidence remains inconsistent, there appears to be a favourable effect of glucose regulation. This effect on morbidity and mortality depends on patient characteristics....
116.
Arginine vasopressin versus norepinephrine: will the stronger one win the race? - Ertmer, Christian; Bone, Hans-Georg; Westphal, Martin
In the current issue of Critical Care, Friesenecker and colleagues present a well-designed comparative study on the microvascular effects of arginine vasopressin (AVP) and norepinephrine (NE) in a physiological, unanesthetized hamster model. The authors clearly demonstrate that AVP, but not NE, has marked vasoconstrictive effects on large arterioles, whereas the impact on small arterioles is comparable for both vasopressors. However, it remains unclear if these results, per se, reflect a stronger vasopressive potential of AVP versus NE, as macrohemodynamic variables were not different between study groups. Since the authors did not investigate the effects of AVP and NE in vasodilatory...
118.
Year in review 2005: Critical Care Respirology: mechanical ventilation, infection, monitoring, and education - Haitsma, Jack J; Villar, Jesús; Slutsky, Arthur S
We summarize all original research in the field of respiratory intensive care medicine published in 2005 in Critical Care. Twenty-seven articles were grouped into the following categories and subcategories to facilitate rapid overview: mechanical ventilation (physiology, spontaneous breathing during mechanical ventilation, high frequency oscillatory ventilation, side effects of mechanical ventilation, sedation, and prone positioning); infection (pneumonia and sepsis); monitoring (ventilatory monitoring, pulmonary artery catheter and pulse oxymeter); and education (training and health outcome).
101.
