Intensive care medicine
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Intensive care medicine · Jun 2011
Comparative StudyEmergence of autoantibodies to HMGB1 is associated with survival in patients with septic shock.
To assess the prevalence and predictive value of natural autoantibodies to high-mobility group box 1 (HMGB1) during sepsis. ⋯ This study shows that autoantibodies to HMGB1 are produced during sepsis and are associated with a favorable outcome in patients undergoing septic shock.
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Intensive care medicine · Jun 2011
Early rise in circulating endothelial protein C receptor correlates with poor outcome in severe sepsis.
The endothelial protein C receptor (EPCR) negatively regulates the coagulopathy and inflammatory response in sepsis. Mechanisms controlling the expression of cell-bound and circulating soluble EPCR (sEPCR) are still unclear. Moreover, the clinical impact of EPCR shedding and its potential value to predict sepsis progression and outcome remain to be established. ⋯ Severe sepsis, at the onset, only triggers moderate quantitative changes in plasma sEPCR levels. Our findings suggest that in severe sepsis, an early (at D2), transient but significant increase in circulating sEPCR may be detrimental suggesting that sEPCR could provide an early biological marker of sepsis outcome.
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Intensive care medicine · Jun 2011
Repeated measurements of endothelin-1 precursor peptides predict the outcome in community-acquired pneumonia.
Excessive activation of the endothelium is associated with adverse outcomes in patients with systemic infections. Endothelium-associated peptides, such as endothelin-1 (ET-1), correlate closely with endothelial activation, and therefore serve as surrogate biomarkers. Our aim was to investigate precursor peptides of endothelin-1 (proET1) on admission and during follow-up on days 3, 5 and 7 in a prospective cohort of 925 patients with community-acquired pneumonia. ⋯ In community-acquired pneumonia, ET-1 precursor peptides on admission and changes from baseline to day 3 were independent predictors for mortality and ICU admission, and significantly improved the PSI. If verified in intervention studies, monitoring of proET1 may be helpful for endothelium targeting therapies and for risk stratification complementary to other prohormones.
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Intensive care medicine · Jun 2011
Comparative StudyThe deteriorating ward patient: a Swedish-Australian comparison.
Most centres in Europe have not introduced a rapid response team (RRT), partly because of concerns that data from other health-care systems may not be relevant. We tested whether patient characteristics and outcomes for deteriorating patients differ between two health-care systems separated by distance and culture. ⋯ In two different health-care systems separated by geography, language, culture and organizational features, the characteristics of deteriorating ward patients, their disposal and outcomes were similar, suggesting that the care of the deteriorating ward patient is a global problem in modern hospitals and confirming that their hospital mortality is high.
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Intensive care medicine · Jun 2011
Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury.
We evaluated whether oscillatory compliance (C(X5)) measured by forced oscillation technique (FOT) at 5 Hz may be useful for positive end-expiratory pressure (PEEP) optimisation. ⋯ The assessment of C(X5) allowed the definition of PEEP(ol) to be in agreement with CT data. Thus, FOT measurements of C(X5) may provide a non-invasive bedside tool for PEEP titration.