Critical care medicine
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Critical care medicine · Jun 2016
Iron Parameters Determine the Prognosis of Critically Ill Patients.
Because iron is both an essential and toxic micronutrient influencing the development of microbial infections, we evaluated the usefulness of iron parameters as outcome predictors in ICU patients. ⋯ Our findings demonstrate that parameters of iron metabolism, particularly transferrin saturation, that reflect serum iron availability, are strong outcome predictors in ICU patients. These data suggest that a failure of iron homeostasis with increased iron availability in serum occurs in lethally ill ICU patients and should trigger prospective clinical trials evaluating the usefulness of iron-chelating therapy in critical illness and sepsis.
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Critical care medicine · Jun 2016
Observational StudyGlucocorticoid Sensitivity Is Highly Variable in Critically Ill Patients With Septic Shock and Is Associated With Disease Severity.
To measure tissue glucocorticoid sensitivity in patients with septic shock and determine its relationship to standard measurements of adrenal function and of outcome. ⋯ Patients with septic shock and controls do not differ in their median glucocorticoid sensitivity. However, patients exhibited a greater variability in glucocorticoid responsiveness and had evidence of association between increased sickness sensitivity and reduced glucocorticoid sensitivity. Sensitivity to glucocorticoids did not appear to be mediated by changes in the expression of the β variant of the glucocorticoid receptor or the 11-β hydroxysteroid dehydrogenase 2 isozyme.
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Critical care medicine · Jun 2016
Randomized Controlled Trial Comparative StudyBeneficial Effects of Early Enteral Nutrition After Major Rectal Surgery: A Possible Role for Conditionally Essential Amino Acids? Results of a Randomized Clinical Trial.
To investigate direct postoperative outcome and plasma amino acid concentrations in a study comparing early enteral nutrition versus early parenteral nutrition after major rectal surgery. Previously, it was shown that a low plasma glutamine concentration represents poor prognosis in ICU patients. ⋯ Lower plasma glutamine and arginine concentrations were measured in the enteral group, whereas a better clinical outcome was observed. We conclude that plasma amino acids do not provide a causal explanation for the observed beneficial effects of early enteral feeding after major rectal surgery.
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Critical care medicine · Jun 2016
Randomized Controlled Trial Multicenter StudyA Binational Multicenter Pilot Feasibility Randomized Controlled Trial of Early Goal-Directed Mobilization in ICU.
To determine if the early goal-directed mobilization intervention could be delivered to patients receiving mechanical ventilation with increased maximal levels of activity compared with standard care. ⋯ Key Practice Points: Delivery of early goal-directed mobilization within a randomized controlled trial was feasible, safe and resulted in increased duration and level of active exercises.
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Critical care medicine · Jun 2016
Randomized Controlled Trial Comparative StudyA Pilot Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support Versus Proportional Assist Ventilation.
Despite protocols incorporating spontaneous breathing trials, 31% of ICU patients experience difficult or prolonged weaning from mechanical ventilation. Nonfatiguing modes such as pressure support ventilation are recommended. Proportional assist ventilation provides assistance in proportion to patient effort, which may optimize weaning. However, it is not known how proportional assist ventilation performs relative to pressure support ventilation over a prolonged period in the complex ICU setting. The purpose of this study was to compare the physiologic and clinical performance (failure rate), safety, and feasibility of protocols using daily spontaneous breathing trial plus pressure support ventilation versus proportional assist ventilation until ventilation discontinuation. ⋯ This pilot study demonstrates the utility, safety, and feasibility of the weaning protocols and provides important information to guide the design of a future randomized controlled trial comparing weaning from mechanical ventilation on pressure support ventilation versus proportional assist ventilation.