Critical care medicine
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Critical care medicine · Jun 2008
Psychiatric illness in the next of kin of patients who die in the intensive care unit.
To determine the rates of psychiatric illness in next of kin following the death of a relative in a medical intensive care unit. ⋯ In a cohort of bereaved next of kin of patients who died in the intensive care unit, we identified a high prevalence of psychiatric illness, particularly major depressive disorder. More work is needed to identify those at risk for psychiatric illness so that appropriate interventions may be targeted.
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Critical care medicine · Jun 2008
Increased plasma interleukin-6 in donors is associated with lower recipient hospital-free survival after cadaveric organ transplantation.
Brain death induces a massive inflammatory response. However, the influence of this inflammatory response on organ procurement, transplantation, and recipient outcome is unknown. We describe the inflammatory response characteristics in brain-dead organ donors and examine associations with organ transplantation and recipient survival. We test the hypothesis that increased inflammatory response is associated with fewer organs transplanted and decreased recipient survival. ⋯ Among brain-dead organ donors, older age donors contribute fewer organs for transplantation, and increased donor interleukin-6 level before organ procurement is associated with lower recipient six-month hospital-free survival.
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Critical care medicine · Jun 2008
Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them.
Both physicians and nurses play important roles in discussing do not resuscitate (DNR) orders with patients and surrogates. However, the beliefs and attitudes of health professionals about the role nurses should play in this process have received little systematic study. ⋯ Staff nurses were more likely than their physician colleagues to believe they should be allowed to initiate DNR discussions, were more confident in their ability to discuss DNR than house officers, and had more positive attitudes. These results suggest further exploration of the role nurses should play in the DNR process.
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Critical care medicine · Jun 2008
Comparative StudyLevosimendan but not norepinephrine improves microvascular oxygenation during experimental septic shock.
To determine the effects of norepinephrine and levosimendan on microvascular perfusion and oxygenation in a rat model of septic shock. ⋯ In this model, treatment with levosimendan and norepinephrine showed comparable effects in restoring CO and had no significant influence on microvascular perfusion. However, only levosimendan significantly improved microPO2, suggesting that a mechanism relatively independent of macrocirculatory hemodynamics and overall microvascular perfusion might account for these observations.
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Critical care medicine · Jun 2008
Editorial Comment Comparative StudyHypothermia and coronary intervention after cardiac arrest: thawing a cool relationship?