Critical care medicine
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Critical care medicine · Jan 2012
Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning.
To examine the impact of delirium during intensive care unit stay on long-term health-related quality of life and cognitive function in intensive care unit survivors. ⋯ Intensive care survivors with delirium during their intensive care unit stay had a similar adjusted health-related quality of life evaluation, but significantly more cognitive problems than those who did not suffer from delirium, even after adjusting for relevant covariates. In addition, the duration of delirium was related to long-term cognitive problems.
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Critical care medicine · Jan 2012
Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia.
We developed a novel pyrrole analog of etomidate, (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate), which retains etomidate's desirable anesthetic and hemodynamic properties but lacks its potent inhibitory affect on adrenocorticotropic hormone-stimulated steroid synthesis. The objective of this study was to test the hypothesis that in contrast to etomidate, carboetomidate neither suppresses the adrenocortical response to endotoxemia nor enhances the accompanying production of proinflammatory cytokines. ⋯ Compared with etomidate, carboetomidate produces less suppression of adrenocortical function and smaller increases in proinflammatory cytokine production in an endotoxemia model of sepsis. These findings suggest that carboetomidate could be a useful alternative to etomidate for maintaining anesthesia for a prolonged period of time in patients with sepsis.
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Critical care medicine · Jan 2012
Intensive care unit readmissions in U.S. hospitals: patient characteristics, risk factors, and outcomes.
To examine which patient characteristics increase the risk for intensive care unit readmission and assess the association of readmission with case-mix adjusted mortality and resource use. ⋯ Intensive care readmission is associated with patient factors that reflect a greater severity and complexity of illness, resulting in a higher risk for hospital mortality and a longer hospital stay. To improve patient safety, physicians should consider these risk factors when making intensive care discharge decisions. Because intensive care unit readmission correlates with more complex and severe illness, readmission rates require case-mix adjustment before they can be properly interpreted as quality measures.
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Critical care medicine · Jan 2012
Efficacy of selective mineralocorticoid and glucocorticoid agonists in canine septic shock.
Corticosteroid regimens that stimulate both mineralocorticoid and glucocorticoid pathways consistently reverse vasopressor-dependent hypotension in septic shock but have variable effects on survival. The objective of this study was to determine whether exogenous mineralocorticoid and glucocorticoid treatments have distinct effects and whether the timing of administration alters their effects in septic shock. DESIGN, SETTING, SUBJECTS, AND INTERVENTIONS: Desoxycorticosterone, a selective mineralocorticoid agonist; dexamethasone, a selective glucocorticoid agonist; and placebo were administered either several days before (prophylactic) or immediately after (therapeutic) infectious challenge and continued for 96 hrs in 74 canines with staphylococcal pneumonia. ⋯ In septic shock, mineralocorticoids are only beneficial if given prophylactically, whereas glucocorticoids are most beneficial when given close to the onset of infection. Prophylactic mineralocorticoids should be further investigated in patients at high risk to develop sepsis, whereas glucocorticoids should only be administered therapeutically to prevent adrenal suppression and worse outcomes.
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Critical care medicine · Jan 2012
Predicting fluid responsiveness with stroke volume variation despite multiple extrasystoles.
To investigate the ability of a new stroke volume variation algorithm to predict fluid responsiveness during general anesthesia and mechanical ventilation in animals with multiple extrasystoles. ⋯ In contrast to the standard stroke volume variation, the new stroke volume variation algorithm was able to predict fluid responsiveness in animals with multiple ventricular extrasystoles.