Critical care medicine
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Critical care medicine · Sep 2018
Randomized Controlled Trial Multicenter StudyPrevention of Nosocomial Infections in Critically Ill Patients With Lactoferrin: A Randomized, Double-Blind, Placebo-Controlled Study.
To obtain preliminary evidence for the efficacy of lactoferrin as a preventative measure for nosocomial infections and inform the conduct of a definitive study. ⋯ Lactoferrin did not improve the primary outcome of antibiotic-free days, nor any of the secondary outcomes. Our data do not support the conduct of a larger phase 3 trial.
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Critical care medicine · Sep 2018
ReviewCritical Care Management of Anti-N-Methyl-D-Aspartate Receptor Encephalitis.
Anti-N-methyl-D-aspartate receptor encephalitis is considered an immune-mediated form of encephalitis with paraneoplastic and nonparaneoplastic forms. Delay in recognition is common and patients typically present to the ICU without a diagnosis or with complications following a delayed diagnosis. The aim of this review is to provide a focused overview for the ICU clinician regarding presentation, diagnosis, and critical care management. ⋯ Intensivists should be familiar with the presentation and management of anti-N-methyl-D-aspartate receptor encephalitis. Early diagnosis and immediate implementation of steroids, immunoglobulins, and/or plasmapheresis and immune therapy are associated with a good neurologic outcome although response may be delayed. The selection and timing of second-line immune therapy requires further study.
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Critical care medicine · Sep 2018
Meta AnalysisCorticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis.
This systematic review and meta-analysis addresses the efficacy and safety of corticosteroids in critically ill patients with sepsis. ⋯ In critically ill patients with sepsis, corticosteroids possibly result in a small reduction in mortality while also possibly increasing the risk of neuromuscular weakness.
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Critical care medicine · Sep 2018
Randomized Controlled TrialExploratory Application of Neuropharmacometabolomics in Severe Childhood Traumatic Brain Injury.
To employ metabolomics-based pathway and network analyses to evaluate the cerebrospinal fluid metabolome after severe traumatic brain injury in children and the capacity of combination therapy with probenecid and N-acetylcysteine to impact glutathione-related and other pathways and networks, relative to placebo treatment. ⋯ This proof-of-concept neuropharmacometabolomics assessment reveals alterations in known and previously unidentified metabolic pathways and supports therapeutic target engagement of the combination of probenecid and N-acetylcysteine treatment after severe traumatic brain injury in children.
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Critical care medicine · Sep 2018
Comparative Study Observational StudyAdenosine Plasma Level and A2A Receptor Expression in Patients With Cardiogenic Shock.
To investigate whether adenosine A2A receptors lead to vasodilation and positive inotropic function under stimulation and whether they play a role in the control of blood pressure in patients with cardiogenic shock. ⋯ We observed high adenosine plasma level and low A2A receptor expression at admission in patients with cardiogenic shock versus acute heart failure or acute myocardial infarction. This may contribute to the physiopathology of cardiogenic shock.