Critical care medicine
-
Critical care medicine · Jun 2013
Comparative StudyReducing deep sedation and delirium in acute lung injury patients: a quality improvement project.
Deep sedation and delirium are common in the ICU. Mechanically ventilated patients with acute lung injury are at especially high risk for deep sedation, delirium, and associated long-term physical and neuropsychiatric impairments. We undertook an ICU-wide structured quality improvement project to decrease sedation and delirium. ⋯ Through a structured quality improvement process, use of sedative infusions can be substantially decreased and days awake without delirium significantly increased, even in severely ill, mechanically ventilated patients with acute lung injury.
-
Critical care medicine · Jun 2013
Maximal chemiluminescent intensity in response to lipopolysaccharide assessed by endotoxin activity assay on admission day predicts mortality in patients with sepsis.
Sepsis is the leading cause of death among critically ill patients. There are, however, few appropriate biomarkers to predict mortality in patients with sepsis. We focused on maximal chemiluminescent intensity in response to lipopolysaccharide assessed by endotoxin activity assay and evaluated the diagnostic value of maximal chemiluminescent intensity on admission day as a predictor of mortality in patients with sepsis. ⋯ Maximal chemiluminescent intensity level measured on admission day appears to have high predictive value for mortality in patients with sepsis.
-
Critical care medicine · Jun 2013
Peripheral neural detection of danger-associated and pathogen-associated molecular patterns.
Bidirectional links between the nervous and immune systems modulate inflammation. The cellular mechanisms underlying the detection of danger-associated molecular patterns and pathogen-associated molecular patterns by the nervous system are not well understood. We hypothesized that the carotid body, a tissue of neural crest origin, detect pathogen associated molecular patterns and danger associated molecular patterns via an inflammasome-dependent mechanism similar to that described in immune cells. ⋯ In carotid body chemosensitive glomus cells, activation of toll-like receptors increases NLRP3 inflammasome expression, and enhances IL-1β production, which is capable of acting in an autocrine manner to enhance peripheral chemoreceptor drive.