Critical care medicine
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Critical care medicine · Apr 2002
Comparative StudyPlasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates.
To determine the relationship between plasma procalcitonin (PCT) levels, C-reactive protein (CRP), white blood cell count (WBC), ionized calcium (Ca2+), and patient outcome; and to compare the diagnostic and prognostic information provided by PCT and by CRP. ⋯ PCT levels were correlated with the severity of disease at onset (APACHE II) and inflammation (CRP) but not with Ca2+ levels. Inaugural PCT or CRP levels per se poorly predicted outcome but decreasing levels were associated with a higher probability of survival. In this respect, PCT was found to be an earlier marker than CRP.
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Critical care medicine · Apr 2002
Comparative StudyIncreased bone resorption in the critically ill: association with sepsis and increased nitric oxide production.
Cytokines stimulate nitric oxide production in bone, and high concentrations of cytokine-induced nitric oxide inhibit bone resorption in vitro. This has led to the suggestion that nitric oxide may protect against bone loss in inflammatory and infectious diseases. In this study, we sought to determine whether nitric oxide generated as the result of sepsis was associated with suppression of bone resorption in vivo. ⋯ Critically ill patients with sepsis have increased nitric oxide production and increased bone resorption, whereas trauma patients have increased bone resorption in the presence of normal nitric oxide production. High concentrations of nitric oxide generated during the course of infection do not afford significant protection against accelerated bone resorption.
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Critical care medicine · Apr 2002
Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis.
To determine the prevalence of deep vein thrombosis (DVT) among patients requiring prolonged mechanical ventilation in the intensive care unit. ⋯ The occurrence of DVT is common among patients requiring prolonged mechanical ventilation in the intensive care unit setting despite the use of prophylaxis measures. These data suggest that alternative strategies for the prevention of DVT should be evaluated. Additionally, early detection methods should be considered to reduce the potential morbidity associated with untreated DVT in this high-risk population.
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Critical care medicine · Apr 2002
Comparative StudySystemic endothelial activation is greater in septic than in traumatic-hemorrhagic shock but does not correlate with endothelial activation in skin biopsies.
Sepsis and severe trauma result in endothelial activation and damage. The activated endothelium expresses adhesion receptors that control leukocyte trafficking. After activation, some adhesion molecules are also released into plasma as soluble forms. The present study was designed to compare the expression of soluble cell adhesion molecules (sCAMs) in three groups of patients: those with septic shock, severe sepsis, and traumatic-hemorrhagic shock. In addition, the endothelial expression of these adhesive molecules was examined in skin biopsies. ⋯ The patterns of sCAMs indicate that the systemic activation of the endothelium is different in the three clinical entities, maximum in septic shock, intermediate in severe sepsis, and not different from controls in traumatic-hemorrhagic shock. Comparable endothelial activation as evidenced by skin biopsies suggests that caution is required in the interpretation of CAMs in plasma, which does not necessarily reflect the in situ activation state of endothelium.
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Critical care medicine · Apr 2002
Impact of a pediatric clinical pharmacist in the pediatric intensive care unit.
To study the impact of a clinical pharmacist in a pediatric intensive care unit. The goals of the study were to determine the type and quantity of patient care interventions recommended by a clinical pharmacist and to specifically examine cost savings (or loss) that resulted from clinical pharmacist recommendations. ⋯ We conclude that a clinical pharmacist is an important and cost-effective member of the pediatric intensive care unit team.