Critical care medicine
-
Critical care medicine · Jan 2008
Multicenter Study Comparative StudyA retrospective observational study of drotrecogin alfa (activated) in adults with severe sepsis: comparison with a controlled clinical trial.
To compare characteristics and outcomes of patients treated with drotrecogin alfa (activated) (DrotAA) in clinical practice to those treated in a phase III randomized controlled trial (PROWESS). ⋯ Patients treated in clinical practice differed from those in PROWESS. Patients were younger, had more comorbidities, had greater severity of illness, and had longer mean time from severe sepsis onset to the start of DrotAA. Hospital mortality for patients treated within 1 day of severe sepsis onset was similar to DrotAA-treated PROWESS patients. While the low number of serious bleeding events precludes a definitive assessment, the observed incidence of serious bleeding events in clinical practice patients was numerically higher than in DrotAA-treated PROWESS patients.
-
Critical care medicine · Jan 2008
Clinical TrialDuffy antigen modifies the chemokine response in human endotoxemia.
The Duffy receptor is a promiscuous receptor for chemokines and selectively binds CXC and CC chemokines with high affinity. Preclinical data show that presence of the Duffy receptor on red blood cells may influence plasma levels of proinflammatory cytokines and chemokines and be protective during inflammation. This trial was designed to investigate the influence of the Duffy antigen on human inflammation in vivo. ⋯ The Duffy antigen substantially alters chemokine concentrations in blood, but it does not have a protective effect during human endotoxemia.
-
Critical care medicine · Jan 2008
Comparative StudyOxygen saturation determined from deep muscle, not thenar tissue, is an early indicator of central hypovolemia in humans.
To compare the responses of noninvasively measured tissue oxygen saturation (StO2) and calculated muscle oxygen tension (PmO2) to standard hemodynamic variables for early detection of imminent hemodynamic instability during progressive central hypovolemia in humans. ⋯ Spectroscopic assessment of forearm muscle PO2 and SmO2 provides noninvasive and continuous measures that are early indicators of impending cardiovascular collapse resulting from progressive reductions in central blood volume.
-
Critical care medicine · Jan 2008
Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database.
Intensive care unit (ICU) outcomes have been the subject of controversy. The objective was to model hospital mortality and ICU length-of-stay time-change of patients recorded in the Australian and New Zealand Intensive Care Society adult patient database. ⋯ Overall hospital mortality rate in patients admitted to Australian and New Zealand ICUs decreased 4% over 11 yrs. A similar trend occurred for mechanically ventilated patients. Length of stay changed minimally over this period.
-
Critical care medicine · Jan 2008
Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survival.
To determine whether extravascular lung water predicts survival in patients with early acute respiratory distress syndrome, to determine the relationship between extravascular lung water and other markers of lung injury, and to examine if indexing extravascular lung water with predicted body weight (EVLWp) strengthens its discriminative power. ⋯ Increased extravascular lung water is a feature of early acute respiratory distress syndrome and predicts survival. Indexing extravascular lung water to predicted body weight, instead of actual body weight, improves the predictive value of extravascular lung water for survival and correlation with markers of disease severity.