Journal of intensive care medicine
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J Intensive Care Med · Jan 2009
Randomized Controlled TrialA new immunomodulatory therapy for severe sepsis: Ulinastatin Plus Thymosin {alpha} 1.
To study the effect of immunomodulatory therapy with ulinastatin plus thymosin alpha( 1) on septic patients. ⋯ Combined immunomodulatory therapy with ulinastatin plus thymosin alpha(1) appears to yield improved survival for patients with sepsis; this finding should be verified in larger clinical trials.
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The most common infectious complication in critically ill patients is ventilator-associated pneumonia. Ventilator-associated pneumonia has significant morbidity and mortality, prolongs mechanical ventilation, and extends length of hospitalization. Despite its prevalence and impact, uniform diagnostic standards are lacking. ⋯ The purpose of this article is to review the evidence supporting the clinical pulmonary infection score as an adjunct to distinguish and detect clinically relevant ventilator-associated pneumonia and its use to guide length of therapy. This score combines clinical diagnostic criteria (tracheal secretion quantification and body temperature) with routinely obtained laboratory data (white blood cell count and oxygenation parameters), radiographic data, and bacteriological culture results. Limitations of clinical pulmonary infection score will be discussed.
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J Intensive Care Med · Jan 2009
Multicenter StudyReview of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort.
To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury. ⋯ Negative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness.
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J Intensive Care Med · Jan 2009
Controlled Clinical TrialDiagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis.
Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases. ⋯ The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins. Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection. C-reactive protein, Sequential Organ Failure Assessment score, age, and gender showed to be helpful to improve the prediction of mortality risk, but not procalcitonin.
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J Intensive Care Med · Jan 2009
The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit.
The purpose of this study was to determine the effects of a simple low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit. ⋯ The implementation of a simple, low-cost oral care protocol in the surgical intensive care unit led to a significantly decreased risk of acquiring ventilator-associated pneumonia.