Journal of critical care
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Journal of critical care · Jun 2012
Comparative Study Clinical TrialNear-infrared spectroscopy cerebral and somatic (renal) oxygen saturation correlation to continuous venous oxygen saturation via intravenous oximetry catheter.
Near-infrared spectroscopy (NIRS) and continuous central venous oxygen saturation (ScvO(2)) via oximetry catheter are 2 modalities available to estimate adequacy of oxygen delivery in postoperative pediatric cardiac patients. Near-infrared spectroscopy measures regional tissue oxygenation and is routinely used in pediatric cardiac surgery patients. By not requiring an invasive catheter, NIRS has the advantage over mixed venous oxygen saturation (SvO(2)) monitoring. An alternative marker of global tissue oxygenation is central venous oxygen saturation (ScvO(2)). A recently developed pediatric-sized oximetric catheter (PediaSat; Edwards Lifesciences, Irvine, CA, USA) functions as a central venous catheter and provides a continuous ScvO(2) reading, an accepted surrogate to SvO(2). To date, the correlation between NIRS and ScvO(2) has not been quantified. The aim of this study was to examine the strength of the bivariate correlation between NIRS and ScvO(2) measurements. ⋯ In this small cohort of pediatric patients undergoing heart surgery, there was a moderate but statistically significant correlation between the ScvO(2)-catheter and the NIRS-C values. Further studies are required to determine which oxymetric modality of monitoring cardiac output most aids in the postoperative management of these patients.
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Journal of critical care · Jun 2012
Response to the high-dose corticotrophin stimulation test depends on plasma adrenocotropin hormone levels in septic shock.
The use of the high-dose corticotrophin stimulation test (HDCST) as a guide to use low-dose steroid therapy in septic shock is controversial. The adrenocotropin hormone (ACTH) constitutes the immediate stimuli to produce cortisol. We evaluated the correlation of the response to the HDCST with plasma ACTH levels in patients with septic shock. ⋯ Patients with septic shock with higher plasma ACTH values presented a subnormal response to the HDCST. The number of patients who failed to the HDCST was higher as plasma ACTH increased.
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Journal of critical care · Jun 2012
Multicenter StudyClinical factors associated with initiation of renal replacement therapy in critically ill patients with acute kidney injury-a prospective multicenter observational study.
Our objective was to describe the current practice for initiation of RRT in this population. There is uncertainty regarding the optimal time to initiate renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI). ⋯ In ICU patients requiring RRT, there was marked variation in factors that influence start of RRT. RRT initiation with fewer clinical triggers was associated with lower mortality. Timing of RRT may modify survival but requires appraisal in a randomized trial.
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Journal of critical care · Jun 2012
Clinical implications of right ventricular dysfunction in patients with acute symptomatic pulmonary embolism: short- and long-term clinical outcomes.
Right ventricular dysfunction (RVD) has been found to have a negative impact on the short-term prognosis of patients with pulmonary embolism (PE). However, the long-term prognosis of such patients has not been well defined. We evaluated the effect of RVD on short- and long-term mortality in Korean patients with PE. ⋯ Right ventricular dysfunction without hemodynamic instability was not associated with short- or long-term mortality of patients with PE.
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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.