Journal of critical care
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Journal of critical care · Apr 2017
Review Meta AnalysisThe effect of early goal-directed therapy for treatment of severe sepsis or septic shock: A systemic review and meta-analysis.
To assess the effects of early goal-directed therapy (EGDT) on reducing mortality compared with conventional management of severe sepsis or septic shock. ⋯ This meta-analysis was heavily influenced by the recent addition of the trio of trials published after 2014. The results of the recent trio of trials may be biased due to methodological issues. This includes lack of blinding by incorporating similar diagnostic and therapeutic interventions as the original EGDT trial.
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Journal of critical care · Apr 2017
Randomized Controlled TrialHydrochlorothiazide in intensive care unit-acquired hypernatremia: A randomized controlled trial.
Thiazides are suggested as a treatment for intensive care unit (ICU)-acquired hypernatremia (IAH). The primary aim of the study was reducing serum sodium concentration (sNa) in patients with IAH with hydrochlorothiazide (HCT) in comparison to placebo. Secondary end points were a difference in urine sodium concentration (uNa) and duration of severe IAH. ⋯ HCT 25 mg 1 qd did not significantly affect sNa or uNa in patients with IAH.
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Journal of critical care · Apr 2017
Randomized Controlled TrialEffect of thoracic epidural block on infection-induced inflammatory response: A randomized controlled trial.
Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores. ⋯ Thoracic epidural block showed a trend toward better preservation of anti-inflammatory response and clinical recovery that, however, failed to achieve statistical significance (P > .05).
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In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. ⋯ Although ultrasound of the heart is often underused in the setting of trauma, it does have the advantages of being easily accessible, noninvasive, and rapid bedside assessment tool. This review article aims to analyze the potential cardiac injuries in trauma patients, and to provide an elaborate description of the role of echocardiography for their accurate diagnosis.
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Journal of critical care · Apr 2017
ReviewNeurogenic stunned myocardium in subarachnoid hemorrhage.
"Stunned myocardium," characterized by reversible left ventricular dysfunction, was first described via animal models using transient coronary artery occlusion. However, this phenomenon has also been noted with neurologic pathologies and collectively been labeled "neurogenic stunned myocardium" (NSM). Neurogenic stunned myocardium resulting from subarachnoid hemorrhage (SAH) is a challenging pathology due to its diagnostic uncertainty. ⋯ Management remains largely supportive with case reports acknowledging the utility of inotropes such as dobutamine and milrinone and intra-aortic balloon pump when NSM is accompanied by cardiogenic shock. Neurogenic stunned myocardium that follows SAH can result in many complications such as arrhythmias, pulmonary edema, and prolonged intubation, which can negatively impact long-term recovery from SAH and increase morbidity and mortality. This necessitates the need to accurately diagnose and treat NSM.