Journal of critical care
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Journal of critical care · Jun 2012
Randomized Controlled Trial Comparative StudyThe effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock.
Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown. ⋯ These results suggest that levosimendan added to dopamine improves systemic hemodynamics and increases splanchnic perfusion assessed using the user-friendly noninvasive bedside system LiMON in patients with septic shock compared with dobutamine.
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Journal of critical care · Jun 2012
Multicenter StudyThe adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: an important determinant of outcome.
The individual impact of timeliness vs adequacy of empiric antibiotic therapy for a clinical suspicion of ventilator-associated pneumonia (CSVAP) is unknown. Accordingly, in patients with CSVAP and timely initiation of empiric antibiotic therapy, we determined the impact of inadequate therapy (IT). ⋯ In the context of early administration of empiric broad spectrum antibiotics for CSVAP, IT is associated with higher morbidity and mortality.
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Journal of critical care · Jun 2012
Comparative StudyDisagreement between ion selective electrode direct and indirect sodium measurements: estimation of the problem in a tertiary referral hospital.
We estimated the proportion of indirect ion selective electrode (ISE) plasma sodium analyses in intensive care unit (ICU) and hospital wide, exhibiting important disagreement with direct ISE results in relation to abnormal plasma protein concentrations. ⋯ Important disagreement between indirect and direct ISE sodium measurements may exist in up to 1 in 4 ICU specimens and 1 in 12 hospital-wide samples. The main problem is indirect ISE overestimation associated with hypoproteinemia, potentially leading to misclassifications of pseudohypernatremia and pseudonormonatremia. We recommend that hospital laboratories consider standardization using direct ISE sodium measurement.
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Sepsis is a clinical syndrome characterized by a multisystem response to a microbial pathogenic insult consisting of a mosaic of interconnected biochemical, cellular, and organ-organ interaction networks. A central thread that connects these responses is inflammation that, while attempting to defend the body and prevent further harm, causes further damage through the feed-forward, proinflammatory effects of damage-associated molecular pattern molecules. ⋯ We suggest that attempts to improve clinical outcomes by targeting specific components of this network have been unsuccessful due to the lack of an integrative, predictive, and individualized systems-based approach to define the time-varying, multidimensional state of the patient. We highlight the translational impact of computational modeling and other complex systems approaches as applied to sepsis, including in silico clinical trials, patient-specific models, and complexity-based assessments of physiology.
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Journal of critical care · Jun 2012
Pleural antigen assay in the diagnosis of pediatric pneumococcal empyema.
The purpose of the study was to assess the diagnostic value of rapid pneumococcal antigen detection (PAD) in pleural fluid samples of children with empyema. ⋯ Pneumococcal antigen detection in pleural fluid specimens from children provides a rapid, simple, sensitive, and reliable method of diagnosis for pneumococcal empyema at bedside.