Journal of critical care
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Journal of critical care · Feb 2011
Prognostic value of serum zinc levels in critically ill patients.
We investigated the hypothesis that a decline in serum zinc concentrations among critically ill patients is related to mortality, length of stay in the intensive care unit, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores. ⋯ The result of this study supports the fact that organ failure and critical illness lead to a decline in serum zinc concentrations and that administration of zinc may be beneficial for critically ill patients.
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Journal of critical care · Feb 2011
Reduced mortality after the implementation of a protocol for the early detection of severe sepsis.
We evaluate the impact that implementing an in-hospital protocol for the early detection of sepsis risk has on mortality from severe sepsis/septic shock. ⋯ The early detection of sepsis promoted early treatment, reducing in-hospital mortality from severe sepsis/septic shock.
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Journal of critical care · Feb 2011
Oxidative stress as a novel target in pediatric sepsis management.
Sepsis with secondary multisystem organ dysfunction syndrome is the leading cause of death in the pediatric intensive care unit. Increased reactive oxygen species may influence circulating and endothelial cells, contributing to inflammatory tissue injury and explaining the tissue hypoxia paradigm based on microvascular dysfunction. An impaired mitochondrial cellular oxygen utilization, rather than inadequate oxygen delivery, was claimed to play a more important role in the development of multisystem organ dysfunction syndrome. ⋯ Antioxidant supplementation currently in use lacks a mechanistic support. Specific pharmacologic targets, such as mitochondria or Nicotinamide Adenine Dinucleotide Phosphate-Oxidase (NADPH) oxidase system, need to be explored. Furthermore, the early recognition of oxidative damage in these seriously ill patients and the usefulness of oxidative stress biomarkers to define a cut point for more successful therapeutic antioxidant interventions to be instituted would offer a new strategy to improve the outcome of critically ill children.
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Journal of critical care · Feb 2011
Comparative StudyResidents' and nurses' perceptions of team function in the medical intensive care unit.
Team-based care is integral to modern intensive care units (ICUs). Trainee physicians ("residents") serve as core team members who provide direct patient care in academic ICUs. However, little is known about how resident perceptions of ICU team function differ from those of other disciplines. Therefore, we compared residents' perceptions to those of nurses', the other predominant direct caregiver group, in the medical ICU. ⋯ We found important differences in the way that ICU nurses and medical trainee physicians, the predominant types of providers caring for the critically ill in academic medical center ICUs, perceive key aspects of team function. These results may be useful to those responsible for administering academic ICUs as well as to residency program directors developing communication- and team-based curricula.
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Journal of critical care · Feb 2011
Comparative StudyWeaning difficult-to-wean chronic obstructive pulmonary disease patients: a pilot study comparing initial hemodynamic effects of levosimendan and dobutamine.
To compare the short-term hemodynamic effects of levosimendan and dobutamine in chronic obstructive pulmonary disease (COPD) patients experiencing weaning difficulties in relation with increased left ventricular filling pressure. ⋯ Both drugs reduced the magnitude of PAOP increase at SB in difficult-to-wean COPD patients. PAOP increase was reduced to a greater extent by levosimendan.