Journal of critical care
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Journal of critical care · Oct 2012
Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock.
The aim of this study was to evaluate the impact of extracorporeal membrane oxygenation (ECMO) assistance on the clinical outcome of patients with acute myocardial infarction (AMI) that is complicated by profound cardiogenic shock (CS) who received primary percutaneous coronary intervention (PCI). ⋯ Extracorporeal membrane oxygenation-assisted PCI for patients with AMI that is complicated by profound CS may improve the 30-day and 1-year survival rates.
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Journal of critical care · Oct 2012
Adrenal insufficiency and response to corticosteroids in hypotensive critically ill children with cancer.
Assessment and treatment of adrenal axis function in critically ill pediatric patients with oncologic disorders have not been well elucidated. Critically ill children with oncologic disorders may be at increased risk for adrenal insufficiency (AI). ⋯ Both RAI and AAI were common in this cohort of critically ill pediatric patients with oncologic disorders. Introduction of steroids was associated with a significant reduction in vasopressors dose.
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Journal of critical care · Oct 2012
A risk, injury, failure, loss, and end-stage renal failure score-based trigger for renal replacement therapy and survival after cardiac surgery.
It is controversial whether all critically ill patients with risk, injury, failure, loss, and end-stage renal failure (RIFLE) F class acute kidney injury (AKI) should receive renal replacement therapy (RRT). We reviewed the outcome of open heart surgery patients with severe RIFLE-F AKI who did not receive RRT. ⋯ After cardiac surgery, RRT was typically applied to patients with the most severe clinical presentation irrespective of creatinine levels. A RIFLE score-based trigger for RRT is unlikely to improve patient survival.
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Journal of critical care · Oct 2012
The Sequential Organ Failure Assessment score and copeptin for predicting survival in ventilator-associated pneumonia.
Ventilator-associated pneumonia remains the most common nosocomial infection in the critically ill and contributes to significant morbidity. Eventual decisions regarding withdrawal or maximal therapy are demanding and rely on physicians' experience. Additional objective tools for risk assessment may improve medical judgement. Copeptin, reflecting vasopressin release, as well as the Sequential Organ Failure Assessment (SOFA) score, reflecting the individual degree of organ dysfunction, might qualify for survival prediction in ventilator-associated pneumonia. We investigated the predictive value of the SOFA score and copeptin in ventilator-associated pneumonia. ⋯ The predictive value of serial-measured SOFA significantly exceeds those of single SOFA and copeptin measurements. Serial SOFA scores accurately predict outcome in ventilator-associated pneumonia.
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Journal of critical care · Oct 2012
Fractional excretion of urea as a diagnostic index in acute kidney injury in intensive care patients.
Acute kidney injury (AKI) is a dynamic process that evolves from an early reversible condition to an established disease. Value of urine indices in the event of AKI is uncertain in critically ill patients. The aim of this study was to evaluate the performance of fractional excretion of urea (FeU) for differentiating persistent from transient AKI in patients admitted to the intensive care unit. ⋯ Fractional excretion of urea less than 40% was found to be a sensitive and specific index in differentiating transient from persistent AKI in intensive care unit patients especially if diuretics had been administered.