Critical care medicine
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Critical care medicine · Apr 2009
Derivation and validation of Spo2/Fio2 ratio to impute for Pao2/Fio2 ratio in the respiratory component of the Sequential Organ Failure Assessment score.
The Sequential Organ Failure Assessment (SOFA) score is validated to measure severity of organ dysfunction in critically ill patients. However, in some practice settings, daily arterial blood gas data required to calculate the respiratory component of the SOFA score are often unavailable. The objectives of this study were to derive Spo2/Fio2 (SF) ratio correlations with the Pao2/Fio2 (PF) ratio to calculate the respiratory parameter of the SOFA score, and to validate the respiratory SOFA obtained using SF ratios against clinical outcomes. ⋯ The total and respiratory SOFA scores obtained with imputed SF values correlate with the corresponding SOFA score using PF ratios. Both the derived and original respiratory SOFA scores similarly predict outcomes.
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Critical care medicine · Apr 2009
Review Case ReportsAcute eosinophilic pneumonia: A case report and review of the literature.
Since its original description in 1989, clinicians have documented many cases of acute eosinophilic pneumonia (AEP), but information regarding the appropriate timing of diagnostic testing and treatment continues to be lacking. As a cause of respiratory failure in relatively young individuals, AEP is one of the few diagnoses that will often dramatically alter the intensivist's current therapy. Evidence for effective therapy is anecdotal and may even suggest that the traditional treatment with steroids offers limited benefit. This review uses a patient with AEP to emphasize certain aspects of this illness and discusses the current literature regarding its features, diagnosis, and treatment. ⋯ The diagnostic criteria and treatment of AEP is currently based on data from limited case series. Although these criteria are rigid, a wide variation in symptoms, diagnostic findings, and treatments reported further emphasizes our lack of knowledge regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors in patients with AEP and the benefit of treating with steroids.
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Critical care medicine · Apr 2009
Platelets support pulmonary recruitment of neutrophils in abdominal sepsis.
Recent findings indicate that platelets not only regulate thrombosis and hemostasis but may also be involved in proinflammatory activities. Herein, we hypothesized that platelets may play a role in sepsis by activating and priming circulating neutrophils for subsequent recruitment into the lung. ⋯ These data demonstrate that platelets play a key role in regulating infiltration of neutrophils and edema formation in the lung via upregulation of Mac-1 in abdominal sepsis.
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Critical care medicine · Apr 2009
Caffeine restores myocardial cytochrome oxidase activity and improves cardiac function during sepsis.
Impaired mitochondrial function is a potential cause of sepsis-associated myocardial depression. Cytochrome oxidase (CcOX), the terminal oxidase of the electron transport chain, is inhibited in the septic heart. Caffeine increases CcOX activity by increasing cyclic adenosine monophosphate and protein kinase A activity. We hypothesized that caffeine will restore myocardial CcOX activity, increase cardiac function, and improve survival during sepsis. ⋯ Caffeine may be a novel therapy to treat sepsis-associated myocardial depression.
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Critical care medicine · Apr 2009
Zinc deficiency increases organ damage and mortality in a murine model of polymicrobial sepsis.
Zinc deficiency is common among populations at high risk for sepsis mortality, including elderly, alcoholic, and hospitalized patients. Zinc deficiency causes exaggerated inflammatory responses to endotoxin but has not been evaluated during bacterial sepsis. We hypothesized that subacute zinc deficiency would amplify immune responses and oxidant stress during bacterial sepsis {lsqb;i.e., cecal ligation and puncture (CLP){rsqb; resulting in increased mortality and that acute nutritional repletion of zinc would be beneficial. ⋯ Subacute zinc deficiency significantly increases systemic inflammation, organ damage, and mortality in a murine polymicrobial sepsis model. Short-term zinc repletion provides significant, but incomplete protection despite normalization of inflammatory and organ damage indices.