Critical care medicine
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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.
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Critical care medicine · Apr 2003
Comparative StudyHealth-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population.
To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction. ⋯ This study has shown that preadmission health-related quality of life of our medical, noncoronary patients was substantially reduced compared with a matched general population. This demonstrates the need to take prehospitalization health-related quality of life into account when examining the outcomes of intensive care unit survivors. Multiple organ dysfunction was the major determinant of poor physical health at follow-up, but it had no impact on mental health domains.
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Critical care medicine · Apr 2003
ReviewTransforming growth factor-beta: a mediator of cell regulation in acute respiratory distress syndrome.
To review recent advances in the use of transforming growth factor (TGF)-beta in acute lung injury and to apply this knowledge to understanding the pathophysiology of this syndrome. ⋯ These studies suggest that TGF-beta not only participates in the late phase of acute lung injury, but also might be active early in acute lung injury and potentially could contribute to the development of pulmonary edema. Integrin-mediated local activation of TGF-beta is critical to the development of pulmonary edema in ARDS, and blocking TGF-beta or its activation could be an effective treatment for this disorder.
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Critical care medicine · Apr 2003
Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness.
To establish the prevalence, clinical characteristics, and electrophysiologic features of residual neuromuscular dysfunction after prolonged critical illness. ⋯ Severe weakness requiring prolonged rehabilitation and abnormal clinical neurologic findings are extremely common in survivors of protracted critical illness. Neurophysiologic evidence of chronic partial denervation of muscle consistent with previous critical illness polyneuropathy is almost invariable and can be found up to 5 yrs after intensive care unit discharge in >90% of these long-stay patients. Evidence of myopathy is unusual. These findings have important implications for the management and rehabilitation of intensive care survivors.
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Critical care medicine · Apr 2003
Microalbuminuria in critically ill medical patients: prevalence, predictors, and prognostic significance.
To ascertain the prevalence, predictors, and prognostic significance of microalbuminuria in critically ill patients. ⋯ This study confirms a high prevalence of microalbuminuria in critically ill patients and suggests that an albumin-creatinine ratio >/=100 mg/g is an independent predictor of mortality and hospital stay.