Critical care medicine
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Critical care medicine · Sep 2004
Influence of systemic inflammatory response syndrome on host resistance against bacterial infections.
To determine the relationship between systemic inflammatory response syndrome (SIRS) and host innate immunities against bacterial infections. ⋯ Mphi-associated host antibacterial innate immunities are greatly influenced by SIRS levels. CAMphi, effector cells for the antibacterial innate immunity against E. faecalis, MRSA, and CLP-induced sepsis, are induced in mild SIRS mice. AAMphi with no antibacterial capabilities are generated in mice with severe SIRS. Induction of CAMphi may protect severe SIRS patients against infections.
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Critical care medicine · Sep 2004
Randomized Controlled Trial Clinical TrialEffect of long-term and high-dose antithrombin supplementation on coagulation and fibrinolysis in patients with severe sepsis.
Sepsis is frequently associated with coagulatory activation, which may contribute to deteriorated organ function. Antithrombin is one important endogenous coagulation inhibitor that is therapeutically applied during sepsis. This study investigates the effect of 14-day antithrombin application on coagulatory variables. ⋯ In this first study on long-term antithrombin therapy, antithrombin significantly reduced septic coagulatory response in patients with severe sepsis when given over 14 days.
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Critical care medicine · Sep 2004
Induced hypothermia by central venous infusion: saline ice slurry versus chilled saline.
Surface cooling improves outcome in selected comatose survivors of cardiac arrest. Internal cooling with considerable volumes of intravenous cold saline may accelerate hypothermia induction. This study compares core temperatures in swine after central catheter infusions of saline ice slurry (saline with smoothed 100-microm-size ice particles) vs. an equal volume of chilled saline. We hypothesized that slurry would achieve core hypothermia (32-34 degrees C) more consistently and at a faster rate. ⋯ Cold intravenous fluids rapidly induce hypothermia in swine with intact circulation. A two-phase (liquid plus ice) saline slurry cools more rapidly than an equal volume of cold saline at 0 degrees C. Ice-slurry could be a significant improvement over other cooling methods when rate of cooling and limited infusion volumes are important to the clinician.
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Critical care medicine · Sep 2004
What is taught, what is tested: findings and competency-based recommendations of the Undergraduate Medical Education Committee of the Society of Critical Care Medicine.
Addressing an unexpected shortfall of intensivists requires early identification and training of appropriate personnel. The purpose of this study was to determine how U.S. medical students are currently educated and tested on acute care health principles. HYPOTHESIS/METHODS: A survey of critical care education with telephone follow-up was mailed to the deans of all 126 medical schools. Web site review of medical school curricula for critical care education was performed. Upon invited request, four members of the Undergraduate Medical Education Committee (UGMEC) reviewed 1,200 pool questions of step II of the U.S. Medical Licensing Examination (USMLE) given to graduating medical students for critical care content. Descriptive statistics are employed. ⋯ Graduating medical students are tested (and licensed accordingly) on critical care knowledge, despite an inconsistent exposure to the discipline in medical school. The UGMEC has drafted competency-based recommendations for acute health care delivery that encourage mandatory didactic and procedural critical care training. The UGMEC recommends that critical care rotations with didactic curricula be required for undergraduate education and that acute care procedural skills be an important component of these curricula.