Critical care medicine
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To review the complex interactions of markers of genetic susceptibility for critical illness and acute lung injury. These may affect the responses of critically ill patients to acute lung injury and acute respiratory distress syndrome and may affect outcome. ⋯ The search for an association between functional variants of a gene and clinical phenotype may help to identify key pathophysiological processes of disease. In the future, we will know much about which therapy is best for each individual patient in the intensive care unit.
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Critical care medicine · Apr 2003
ReviewLung recruitment maneuvers in acute respiratory distress syndrome and facilitating resolution.
To summarize the possible ways that acute respiratory distress syndrome (ARDS) lungs can be recruited and to present the experimental and clinical results of these maneuvers, along with the possible effects on patient outcome. ⋯ High airway pressures can open collapsed ARDS lungs and partially open edematous ARDS lungs. High PEEP levels and low tidal volume ventilation decrease bronchoalveolar and plasma inflammatory mediators and improve survival compared with low PEEP/high tidal volume ventilation. In the near future, thoracic computed tomography associated with high-performance monitoring of regional ventilation (electrical impedance tomography) may be used at the bedside to determine the optimal mechanical ventilation of ARDS patients.
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Critical care medicine · Apr 2003
ReviewEpidemiology and outcome of acute respiratory failure in intensive care unit patients.
To summarize the prevalence of various forms of acute respiratory failure in acutely ill patients and review the major factors involved in the outcome of these patients. ⋯ The prevalence of acute respiratory failure varies according to the definition used and the population studied. Nonsurvivors of acute respiratory distress syndrome die predominantly of respiratory failure in <20% of cases. The relatively high mortality rates of acute lung injury/acute respiratory distress syndrome are primarily related to the underlying disease, the severity of the acute illness, and the degree of organ dysfunction.
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To review recent advances in the field of endothelial cell heterogeneity, and to apply this knowledge to an understanding of site-specific vasculopathy, including acute lung injury. ⋯ The structure and function of endothelial cells are differentially regulated in space and time. Far from being a giant monopoly of homogeneous cells, the endothelium represents a consortium of smaller enterprises of cells located within blood vessels of different tissues. Although united in certain functions, each enterprise is uniquely adapted to meet the demands of the underlying tissue. The endothelium may also vary in its response to pathophysiologic stimuli and therefore contribute to the focal nature of vasculopathic disease states. In acute lung injury, the unique properties of the endothelium may conspire with systemic imbalances to localize pathology to the pulmonary vasculature.
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Critical care medicine · Apr 2003
Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients.
The impact of resistant (vs. nonresistant) Gram-negative infections on mortality remains unclear. We sought to define risk factors for and excess mortality from these infections. ⋯ rGNRs are associated with prolonged hospital stay and increased mortality. Infection with rGNRs independently predicts mortality; however, this may be more closely related to selection of certain bacterial species with a high frequency of resistance rather than actual resistance to antibiotic therapy. Therefore, altering infection-control practices to limit the dissemination of certain bacterial species may be more effective than attempts to control only antibiotic-resistant isolates.