Intensive care medicine
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Intensive care medicine · Jul 2012
ReviewAn overview of anthrax infection including the recently identified form of disease in injection drug users.
Bacillus anthracis infection (anthrax) can be highly lethal. Two recent outbreaks related to contaminated mail in the USA and heroin in the UK and Europe and its potential as a bioterrorist weapon have greatly increased concerns over anthrax in the developed world. ⋯ Anthrax, a gram-positive bacterium, has typically been associated with three forms of infection: cutaneous, gastrointestinal, and inhalational. However, the anthrax outbreak among injection drug users has emphasized the importance of what is now considered a fourth disease form (i.e., injectional anthrax) that is characterized by severe soft tissue infection. While cutaneous anthrax is most common, its early stages are distinct and prompt appropriate treatment commonly produces a good outcome. However, early symptoms with the other three disease forms can be nonspecific and mistaken for less lethal conditions. As a result, patients with gastrointestinal, inhalational, or injectional anthrax may have advanced infection at presentation that can be highly lethal. Once anthrax is suspected, the diagnosis can usually be made with gram stain and culture from blood or tissue followed by confirmatory testing (e.g., PCR). While antibiotics are the mainstay of anthrax treatment, use of adjunctive therapies such as anthrax toxin antagonists are a consideration. Prompt surgical therapy appears to be important for successful management of injectional anthrax.
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Intensive care medicine · Jul 2012
Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study.
This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings). ⋯ Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.
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Intensive care medicine · Jul 2012
Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery.
Prospective validation of the vasoactive-inotropic score (VIS) and inotrope score (IS) in infants after cardiovascular surgery. ⋯ In neonates and infants, a higher VIS at 48 h after cardiothoracic surgery is strongly associated with increased length of ventilation, and prolonged ICU and total hospital stay. At all time points assessed, VIS is more predictive of poor short-term outcome than IS. VIS may be useful as an independent predictor of outcomes.
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Intensive care medicine · Jul 2012
Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection.
Current medical knowledge lacks specific information regarding creatine kinase (CK) elevation in influenza A pH1N1 (2009) infection. ⋯ CK is a biomarker of severity in pH1N1 infection. Elevation of CK was associated with more complications and increased ICU LOS and healthcare resources.
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Intensive care medicine · Jul 2012
Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow.
To assess whether continuous veno-venous hemofiltration (CVVH) with high blood pump flow alters the measurements of cardiac index (CI), global end-diastolic volume indexed (GEDVI), and extravascular lung water indexed (EVLWI) performed by transpulmonary thermodilution. ⋯ CVVH with a high blood flow pump does not alter the transpulmonary thermodilution measurements of CI, GEDVI, and EVLWI.