Critical care medicine
-
Critical care medicine · May 2002
Multicenter StudyAssociation between a genomic polymorphism within the CD14 locus and septic shock susceptibility and mortality rate.
Genetic differences in immune responses may affect susceptibility to and outcome of septic shock. CD14 seems to be an important part of the innate immune system, initiating antimicrobial response. We evaluated the frequency of a recently discovered CD14 promoter gene polymorphism (C to T transition at base pair -159) among patients with septic shock compared with those in a control group. ⋯ The C-159T polymorphism affects susceptibility to septic shock and seems to be a new genetic risk factor for death.
-
Critical care medicine · May 2002
Transcutaneous carbon dioxide monitoring during high-frequency oscillatory ventilation in infants and children.
Continuous monitoring of ventilation during mechanical ventilation may improve patient management by facilitating proactive rather than reactive ventilator adjustments and may decrease the need for repeated arterial blood gas analysis. Because of their more critical pulmonary status, patients requiring high-frequency oscillatory ventilation may especially benefit from continuous monitoring. ⋯ TC(CO2) monitoring provides an accurate and clinically acceptable estimate of PaCO2 over a wide range of CO2 values in pediatric patients during high-frequency oscillatory ventilation.
-
Critical care medicine · May 2002
Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients?
To analyze the time course and changes of cerebral microdialysis parameters after aneurysmal subarachnoid hemorrhage (SAH) in respect to the clinical course (asymptomatic, delayed, and acute ischemic neurologic deficits) to evaluate the method of bedside microdialysis in these patients. ⋯ Cerebral bedside microdialysis is a safe and promising technique for monitoring (impending) regional cerebral ischemia. The dialysate changes can indicate early the onset of delayed neurologic deterioration and are in good accordance with the clinical course of SAH patients. In the future, this technique may be used to monitor the efficacy of the intensive care therapy of these patients.
-
Critical care medicine · May 2002
Early postoperative monocyte deactivation predicts systemic inflammation and prolonged stay in pediatric cardiac intensive care.
Sepsis and systemic inflammatory response syndrome (SIRS) are major causes of morbidity and mortality after cardiopulmonary bypass. Attempts to suppress proinflammatory mediators have failed to improve outcomes in sepsis or in patients undergoing cardiopulmonary bypass. Recent work in adult patients has suggested that the balance between pro- and anti-inflammatory mediators is more important than the level of proinflammatory response alone. This balance may be reflected by the expression of monocyte human lymphocyte antigen (HLA)-DR, with low concentrations indicating an excess of anti-inflammatory stimuli and relative immunodeficiency. We investigated the relationship between monocyte HLA-DR expression and the subsequent development of sepsis/SIRS in children undergoing cardiopulmonary bypass. ⋯ Patients with decreased HLA-DR in the early postoperative period represent a subpopulation at greatly increased risk of later sepsis/SIRS. Such patients may benefit from strategies aimed to reduce this risk.
-
Critical care medicine · May 2002
Osmolar gap hyponatremia in critically ill patients: evidence for the sick cell syndrome?
Accumulation of nondiffusible solutes in plasma leads to redistribution hyponatremia with an increased osmolar gap (i.e., the difference between measured and calculated osmolality). In critically ill patients, intracellular solutes may leak out of the cell because of an increased membrane permeability and may lead to redistribution hyponatremia with increased osmolar gap, a concept called the "sick cell syndrome." The aims of this prospective study were to determine whether an increased osmolar gap related to endogenous solutes accumulation was present in intensive care patients with true hyponatremia and to identify the solutes accounting for this increased osmolar gap. ⋯ Hyponatremia with increased osmolar gap related to endogenous solutes accumulation is observed frequently in hyponatremic intensive care patients, especially in patients with the most severe organ dysfunctions. The nature of the endogenous solutes accounting for the increased osmolar gap remains to be determined. Simultaneous correction of sodium and osmolar gap suggests a causal link between increased osmolar gap and hyponatremia and may support the concept of sick cell syndrome.