Critical care medicine
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Critical care medicine · Oct 2008
Randomized Controlled Trial Comparative StudyIntensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure.
Thrombocytopenia-associated multiple organ failure (TAMOF) is a poorly understood syndrome in critically ill children. A disintegrin and metalloprotease with thrombospondin motifs (ADAMTS-13), formerly known as von Willebrand factor (VWF) cleaving protease, is decreased in adults with VWF-mediated thrombotic microangiopathy, and intensive plasma exchange (PEx) both replenishes ADAMTS-13 and improves outcome in these patients. ⋯ Children with TAMOF syndrome can have VWF-mediated thrombotic microangiopathy. Similar to adult experience, PEx can replenish ADAMTS-13 activity and reverse organ failure.
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Critical care medicine · Oct 2008
Randomized Controlled Trial Comparative StudyImproving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.
Delivery of high-quality cardiopulmonary resuscitation increases survival from cardiac arrest, yet studies have shown that cardiopulmonary resuscitation quality is often poor during actual in-hospital resuscitation. Furthermore, recent work has shown that audiovisual feedback alone during cardiopulmonary resuscitation modestly improves performance. We hypothesized that a multimodal training method comprising audiovisual feedback and immediate debriefing would improve cardiopulmonary resuscitation performance among care providers. ⋯ Significant cardiopulmonary resuscitation quality deficits exist among healthcare providers. Debriefing or feedback alone improved cardiopulmonary resuscitation quality, but the combination led to marked performance improvements. Cardiopulmonary resuscitation feedback and debriefing may serve as a powerful tool to improve rescuer training and care for cardiac arrest patients.
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Critical care medicine · Oct 2008
Randomized Controlled TrialThe effects of CO2 on cytokine concentrations in endotoxin-stimulated human whole blood.
Hypercapnia is known to modulate inflammation in lungs. However, the effect of hypocapnia and hypercapnia on blood cytokine production during sepsis is not well understood. We hypothesized that CO2 modulates ex vivo inflammatory cytokine production during endotoxin stimulation. To test this hypothesis, we measured the production of pro- and anti-inflammatory cytokines in endotoxin-stimulated human whole blood cultures under hypercapnic, normocapnic, and hypocapnic conditions. ⋯ Our results are consistent with the hypothesis that CO2 can affect the production of pro- and anti-inflammatory cytokines after ex vivo stimulation with endotoxin.