Critical care medicine
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Critical care medicine · Mar 2004
Review Practice Guideline GuidelineSurviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.
In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. ⋯ Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that are hoped to translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually and even more rapidly as some important new knowledge becomes as available.
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Critical care medicine · Mar 2004
High concentrations of circulating macrophage migration inhibitory factor in patients with severe blunt trauma: Is serum macrophage migration inhibitory factor concentration a valuable prognostic factor?
To determine serum concentrations of macrophage migration inhibitory factor and other cytokines in severe blunt trauma patients in critical settings and to evaluate their association with patient outcome. ⋯ Our data suggest that the serum macrophage migration inhibitory factor concentration is higher in severe blunt trauma and that it reflects the severity of trauma. The serum macrophage migration inhibitory factor concentration might be a valuable predictor for the outcome of severe blunt trauma.
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Critical care medicine · Mar 2004
Infection in prolonged pediatric critical illness: A prospective four-year study based on knowledge of the carrier state.
This study was performed to determine the rate, timing, and incidence density of infections occurring in a subgroup of patients requiring a prolonged stay in a regional pediatric intensive care unit. ⋯ Two thirds of all infections diagnosed in children with prolonged illness on pediatric intensive care unit were due to microorganisms present in the patients' admission flora.
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Critical care medicine · Mar 2004
Trauma-hemorrhagic shock-induced up-regulation of endothelial cell adhesion molecules is blunted by mesenteric lymph duct ligation.
Previous studies have shown that mesenteric lymph duct ligation prevents trauma-hemorrhagic shock-induced lung injury and neutrophil activation. Since endothelial cells rapidly express adhesion molecules, such as P-selectin and intercellular adhesion molecule-1, after shock, and because trauma-hemorrhagic shock-induced lung injury appears to involve neutrophil-endothelial cell interactions, we tested the hypothesis that lymph duct ligation would diminish trauma-hemorrhagic shock-induced P-selectin and intercellular adhesion molecule-1 expression in the lung and other organs. ⋯ Trauma-hemorrhagic shock-induced increases in endothelial cell P-selectin and intercellular adhesion molecule-1 expression in the lung and liver as well as other tissues appear to be related to factors liberated from the ischemic gut and carried in intestinal lymph.