Critical care medicine
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Critical care medicine · Oct 2007
Comparative StudyMicroorganisms responsible for intravascular catheter-related bloodstream infection according to the catheter site.
Current guidelines for the management of intravascular catheter-related bloodstream infection (IVC-RBSI) recommend that empirical antimicrobial therapy must have activity against Gram-positive bacteria, but additional empirical coverage for Gram-negative bacteria may be needed for severely ill or immunocompromised patients, and antifungal therapy may be needed in some situations. We hypothesized that the spectrum of etiological microorganisms responsible for IVC-RBSI and, in relation to that, the choice of empirical antimicrobial therapy depends on the catheter insertion site. We therefore compared the proportion of IVC-RBSI due to Gram-negative bacteria and yeasts according to catheter site. ⋯ Empirical antifungal therapy would seem to be indicated in patients with suspected femoral catheter-related bloodstream infection.
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Critical care medicine · Oct 2007
Zoniporide preserves left ventricular compliance during ventricular fibrillation and minimizes postresuscitation myocardial dysfunction through benefits on energy metabolism.
To investigate whether sodium-hydrogen exchanger isoform-1 (NHE-1) inhibition attenuates myocardial injury during resuscitation from ventricular fibrillation through effects on energy metabolism, using an open-chest pig model in which coronary perfusion was controlled by extracorporeal circulation. ⋯ Zoniporide ameliorated myocardial injury during resuscitation from ventricular fibrillation through beneficial effects on energy metabolism without effects on coronary vascular resistance and coronary blood flow.
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Critical care medicine · Oct 2007
Conjugated primary bile salts reduce permeability of endotoxin through intestinal epithelial cells and synergize with phosphatidylcholine in suppression of inflammatory cytokine production.
Endotoxemia was shown to be integral in the pathophysiology of obstructive jaundice. In the current study, the role of conjugated primary bile salts (CPBS) and phosphatidylcholine on the permeability of endotoxin through a layer of intestinal epithelial cells and the consequent activation of basolaterally cocultured human mononuclear leukocytes were measured. ⋯ CPBS can reduce the permeation of endotoxin through intestinal epithelial cell layers by binding it to micelles. Thereby, the inflammatory processes beyond the mucosal surface are suppressed, an effect that is enhanced by phosphatidylcholine.
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Critical care medicine · Oct 2007
Low baseline serum creatinine concentration predicts mortality in critically ill patients independent of body mass index.
Malnutrition and low muscle mass reduce the ability of patients to fight critical illness. Low serum creatinine is a better surrogate marker of low muscle mass than a low body mass index and has been associated with poor outcome in some patient populations. We hypothesized that low baseline serum creatinine would predict poor outcome in the critically ill. ⋯ Low baseline serum creatinine concentrations increase the risk of mortality in critically ill patients.
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Critical care medicine · Oct 2007
Case ReportsWeaning from prolonged mechanical ventilation using an antipsychotic agent in a patient with acute stress disorder.
To report the use of a second-generation antipsychotic agent to assist weaning from prolonged mechanical ventilation in an anxious patient. ⋯ A second-generation antipsychotic agent was successfully used to facilitate weaning in a very anxious patient, possibly secondary to anxiolysis or direct effect on respiratory drive. Further investigations of pharmacologic intervention should be done to inform practice guidelines in difficult-to-wean patients suffering from severe anxiety.