Critical care medicine
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Critical care medicine · Sep 2005
Comparative StudyCharacteristics and outcomes for critically ill patients with prolonged intensive care unit stays.
Prolonged stay in the intensive care unit (ICU) is associated with high mortality, morbidity, and costs. Identifying those patients who are most likely to benefit from an extended ICU stay would be helpful in guiding clinical decisions. We sought to describe the characteristics and outcomes for a heterogeneous group of patients who required a prolonged ICU stay. ⋯ We developed a method to broadly classify a heterogeneous population of prolonged-stay ICU patients on the basis of MODS and the ICU interventions received. Mortality among prolonged-stay patients was highest for those with multiple organ failure. Future research should evaluate whether the proposed classification system can be used to influence the delivery of ICU care.
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Critical care medicine · Sep 2005
Ventilation-induced neutrophil infiltration and apoptosis depend on apoptosis signal-regulated kinase 1 pathway.
Positive pressure ventilation with large tidal volumes has been shown to cause release of cytokines, including macrophage inflammatory protein (MIP)-2, a functional equivalent of human interleukin-8, neutrophil infiltration, and apoptosis. The mechanisms regulating ventilation-induced cytokine production and lung cell death are unclear. Based on our previous in vitro and in vivo models of lung cell stretch, we hypothesized that high tidal volume ventilation-induced MIP-2 production, neutrophil infiltration, and apoptosis are dependent on the activation of apoptosis signal-regulated kinase 1 (ASK1), the upstream activator of c-Jun N-terminal kinase (JNK). ⋯ Our data showed that high tidal volume ventilation-induced MIP-2 production, neutrophil sequestration, and apoptotic cell death were dependent, in part, on activation of the ASK1/JNK/AP-1 pathway.
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Critical care medicine · Sep 2005
Oxidant injury occurs rapidly after cardiac arrest, cardiopulmonary resuscitation, and reperfusion.
Investigations conducted in cellular models show that reperfusion of ischemic tissue is associated with a burst of reactive oxidant species within minutes after reperfusion. Oxidant injury may play a role in the poor outcome typical of people resuscitated from cardiac arrest. The objective of the present study was to determine the presence and timing of oxidant injury in an in vivo model of cardiac arrest. ⋯ This study shows that F2-isoprostane measurement could be used to assess oxidant injury in an animal model of cardiac arrest and that oxidant injury occurs rapidly after cardiac arrest and reperfusion.
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Critical care medicine · Sep 2005
Comparative StudyContinuous cardiac output monitoring with pulse contour analysis: a comparison with lithium indicator dilution cardiac output measurement.
Pulse contour analysis can be used to provide beat-to-beat cardiac output (CO) measurement. The current study sought to evaluate this technique by comparing its results with lithium dilution CO (LiCO) measurements. ⋯ PCO measurement compared well with the lithium dilution method and can be considered an accurate technique for measuring beat-to-beat CO with limited risk to the patient.
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Critical care medicine · Sep 2005
Ethyl pyruvate improves systemic and hepatosplanchnic hemodynamics and prevents lipid peroxidation in a porcine model of resuscitated hyperdynamic endotoxemia.
To investigate the systemic, pulmonary, and hepatosplanchnic hemodynamic and metabolic effects of delayed treatment with ethyl pyruvate in a long-term porcine model of hyperdynamic endotoxemia. ⋯ Ethyl pyruvate infusion resulted in improved hemodynamic stability and ameliorated acid-base derangements induced by chronic endotoxemia in pigs. Reduced oxidative stress and an decreased nitric oxide release probably contributed to these effects.