Intensive care medicine
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Intensive care medicine · Mar 2008
Refractory intracranial hypertension and "second-tier" therapies in traumatic brain injury.
To quantify the occurrence of high intracranial pressure (HICP) refractory to conventional medical therapy after traumatic brain injury (TBI) and to describe the use of more aggressive therapies (profound hyperventilation, barbiturates, decompressive craniectomy). ⋯ HICP is frequent and is associated with worse outcome. ICP was controlled by early surgery and first-tier therapies in the majority of cases. Profound hyperventilation, surgical decompression and barbiturates were used in various combinations in a minority of cases. The indications for surgical decompression and/or barbiturates seem restricted to less than 10% of severe TBI.
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Intensive care medicine · Mar 2008
C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study.
The objective was to assess the ability of potential clinical predictors and inflammatory markers within 24 h of intensive care unit (ICU) discharge to predict subsequent in-hospital mortality. ⋯ A high CRP concentration at ICU discharge was an independent predictor of in-hospital mortality after ICU discharge in our ICU.
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Intensive care medicine · Mar 2008
Recognition and labeling of delirium symptoms by intensivists: does it matter?
The approach to acute cognitive dysfunction varies among physicians, including intensivists. Physicians may differ in their labeling of cognitive abnormalities in critically ill patients. We aimed to survey: (a) what Canadian intensive care unit (ICU) physicians identify as "delirium"; (b) choices of non-pharmacological and pharmacological management; and (c) consultation patterns among ICU patients with cognitive abnormalities. ⋯ Canadian intensivists diagnose delirium based upon the presence or absence of an obvious medical etiology. Wide variation exists in approach to management, as well as patterns of consultation.
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Intensive care medicine · Mar 2008
Chronic Escherichia coli infection induces muscle wasting without changing acetylcholine receptor numbers.
Muscle weakness in septic patients is a serious problem as it complicates and lengthens hospital stays, prolongs rehabilitation and increases costs. We examined the effects of a chronic infection with Escherichia coli on muscle function, muscle mass, and the expression of nicotinic acetylcholine receptors (AChRs). ⋯ Central venous injection of E. coli bacteria induces systemic inflammation evidenced as loss of body weight, muscle mass and increased alpha1-acid glycoprotein levels. The inflammation-induced muscle weakness is due to muscle atrophy and not to upregulated AChRs. This model may prove useful for studying maneuvers to prevent muscle wasting with inflammation.