Critical care medicine
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Critical care medicine · Oct 2007
Comparative StudyComparison of two dose regimens of arginine vasopressin in advanced vasodilatory shock.
To evaluate the effects of two arginine vasopressin (AVP) dose regimens (0.033 vs. 0.067 IU/min) on treatment efficacy, hemodynamic response, prevalence of adverse events, and changes in laboratory variables. ⋯ AVP dosages of 0.067 IU/min seem to be more effective to reverse cardiovascular failure in vasodilatory shock requiring high norepinephrine dosages than 0.033 IU/min.
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Critical care medicine · Oct 2007
Trends in acute renal failure associated with coronary artery bypass graft surgery in the United States.
Acute renal failure remains a major complication of coronary artery bypass graft surgery that is strongly associated with in-hospital mortality. Based on similar observations in other clinical settings, we tested the hypothesis that the diagnosis of acute renal failure associated with coronary artery bypass graft surgery is increasing in the United States. ⋯ Our findings suggest that the observed increase in acute renal failure diagnosis rates may be partly attributable to less restrictive criteria for acute renal failure diagnosis, consistent with acute renal failure patterns observed in other clinical settings. Although the need for dialysis is a relatively clear benchmark for diagnosing acute renal failure, use of alternate criteria to define this disorder has become more common, perhaps contributing to higher diagnosis rates. We conclude that the nationwide trend of acute renal failure associated with coronary artery bypass graft surgery has significantly increased from 1988 to 2003. Despite declining mortality, acute renal failure remains a burden on healthcare resources.
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Critical care medicine · Oct 2007
Severe hypoglycemia in critically ill patients: risk factors and outcomes.
To determine the risk factors for development of severe hypoglycemia (defined as glucose <40 mg/dL) in critically ill patients and define the outcomes of this complication. ⋯ Case-control methodology and multivariable logistic regression analysis concurred that even a single episode of severe hypoglycemia was independently associated with increased risk of mortality. Safe implementation of tight glycemic control requires appropriate monitoring to reduce the risk of this complication.
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Critical care medicine · Oct 2007
Review Case ReportsEuthanasia in intensive care: a 56-year-old man with a pontine hemorrhage resulting in a locked-in syndrome.
To describe a case of deliberate termination of life (euthanasia) in intensive care. ⋯ Euthanasia is an option in terminal illness in the Netherlands, but it is very rarely performed in intensive care. This case demonstrates that euthanasia is possible in a conscious patient who is unable to speak or write and who is mechanically ventilated.
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The past several years have seen remarkable advances in understanding the basic cellular and physiologic mechanisms underlying organ dysfunction and recovery relating to sepsis. Although several new therapeutic approaches have improved outcome in septic patients, the far-reaching potential of these new insights into sepsis-associated mechanisms is only beginning to be realized. ⋯ Current understanding of the pathophysiology underlying sepsis-induced multiple organ dysfunction highlights the multiple cell populations and cell-signaling pathways involved in this complex condition. There is an increasing appreciation of interactions existing between different cells and organs affected by the septic process. The intricate cross-talk provided by temporal changes in mediators, hormones, metabolites, neural signaling, alterations in oxygen delivery and utilization, and by modifications in cell phenotypes underlines the adaptive and even coordinated processes beyond the dysregulated chaos in which sepsis was once perceived. Many pathologic processes previously considered to be detrimental are now viewed as potentially protective. Applying systems approaches to these complex processes will permit better appreciation of the effectiveness or harm of treatments, both present and future, and also will allow development not only of better directed, but also of more appropriately timed, strategies to improve outcomes from this still highly lethal condition.