Critical care medicine
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Critical care medicine · Jul 2012
Clinical Trial1,25-Dihydroxyvitamin D fluctuations in cardiac surgery are related to age and clinical outcome*.
To investigate the interrelationship between cardiac surgery, age, circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D, and clinical outcome. ⋯ Circulating 1,25-dihydroxyvitamin D levels fluctuate in relation to cardiac surgery. Low 1,25-dihydroxyvitamin D levels are associated with inflammatory processes and age-related differences in clinical outcome. Future studies should determine whether therapies aimed at treating low 1,25-dihydroxyvitamin D levels can improve the outcome in older cardiac surgery patients.
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Critical care medicine · Jul 2012
Treatment limitations at admission to intensive care units in Australia and New Zealand: prevalence, outcomes, and resource use*.
Previous studies have addressed patients in whom treatment is withheld or withdrawn after a period of intensive care unit management. However, no studies have investigated the epidemiology of patients with treatment limitations in place at the time of intensive care unit admission. ⋯ Patients with treatment limitations on intensive care unit admission comprise approximately 2,000 patients per year in Australia and New Zealand. Despite such limitations, almost half of these patients survive their hospital admission and a third return directly to their home.
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Critical care medicine · Jul 2012
Effects of a single-dose hypertonic saline hydroxyethyl starch on cerebral blood flow, long-term outcome, neurogenesis, and neuronal survival after cardiac arrest and cardiopulmonary resuscitation in rats*.
The beneficial effects of hypertonic saline on neuronal survival and on cerebral blood flow have been shown in several animal models of global and focal brain ischemia. Because of the potential benefits of hypertonic solutions, it is hypothesized that hydroxyethyl starch enhances cerebral blood flow and improves long-term outcome after cardiac arrest and cardiopulmonary resuscitation in an animal model. ⋯ Despite promising results in other models of brain injury, hypertonic saline hydroxyethyl starch failed to improve the outcome when administered after asphyxic cardiac arrest/cardiopulmonary resuscitation in rats. One major difference between the cardiac arrest/cardiopulmonary resuscitation model and other models of brain ischemia is that the effects of asphyxic cardiac arrest involve the whole organism (post-cardiac arrest syndrome) and not exclusively the brain leading to a more severe injury. This might explain why hypertonic saline hydroxyethyl starch has failed to improve outcome in the present model.
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Critical care medicine · Jul 2012
Efficacy and toxicity of intravenous iron in a mouse model of critical care anemia*.
Anemia is common in critically ill patients, due to inflammation and blood loss. Anemia can be associated with iron deficiency and low serum hepcidin levels. However, iron administration in this setting remains controversial because of its potential toxicity, including oxidative stress induction and sepsis facilitation. The objective of this work was to determine the efficacy and toxicity of iron administration using a mouse model mimicking critical care anemia as well as a model of acute septicemia. ⋯ Adverse effects of intravenous iron supplementation by ferric carboxymaltose seem to be minimal in our animal models. Furthermore, iron appears to be effective in correcting anemia, despite inflammation. Studies of efficacy and safety of iron in critically ill patients are warranted.
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Critical care medicine · Jul 2012
Antisense inhibition of secretory and cytosolic phospholipase A2 reduces the mortality in rats with sepsis*.
Phospholipase A(2) has been implicated to play a pivotal role in the pathogenesis of sepsis syndrome. The two major forms of phospholipase A(2) isoenzymes, secretory phospholipase A(2) and cytosolic phospholipase A(2), are overexpressed during sepsis. The objective of this study was to test the hypothesis that inhibition of the overexpressed secretory phospholipase A(2) and cytosolic phospholipase A(2) during sepsis benefits the disease's eventual outcome. ⋯ The results demonstrate that antisense strategy against secretory phospholipase A(2) IIa and cytosolic phospholipase A(2) IVa can inhibit their target protein expression in major organs and greatly improve the clinical outcome, i.e., an absolute reduction in 35-day mortality of 30.8%, in rats with sepsis. Our studies, thus, provide an improved method for the treatment of sepsis by targeting multiple forms of phospholipase A(2) isoenzymes with DNA antisense oligomers.