Critical care medicine
-
Critical care medicine · Mar 2002
Multicenter StudyRelationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients.
To determine the relationship between the premortem and postmortem diagnosis in critically ill bone marrow transplantation patients Also, to evaluate the appropriateness of the reliance on clinical diagnosis for withdrawal of active treatment decision-making. ⋯ In the bone marrow transplantation population, there is significant concordance between clinical diagnosis and postmortem findings. Reliance on clinical diagnosis may be valid for withdrawal of active treatment decision-making in these patients.
-
Critical care medicine · Mar 2002
Impaired circadian rhythm of melatonin secretion in sedated critically ill patients with severe sepsis.
Melatonin is involved in the regulation of the sleep-wake cycle and exhibits multiple interactions with the neuroendocrine and the immune system. Melatonin secretion in healthy individuals follows a stable circadian rhythm. Critical illness, continuous administration of drugs, and loss of external zeitgeber might impair the circadian rhythm of melatonin secretion in the intensive care unit (ICU), thereby compromising the physiologic stress-induced immune response. ⋯ The present study revealed striking abnormalities in urinary aMT6s excretion in septic ICU patients. In contrast, circadian rhythm was preserved in nonseptic ICU patients, indicating that impaired circadian melatonin secretion in septic patients is mainly related to the presence of severe sepsis and/or concomitant medication. Further investigations are required to examine the underlying pathophysiologic mechanism and the clinical implications of this finding.
-
Critical care medicine · Mar 2002
Comparative StudyIntensive care unit admission has minimal impact on long-term mortality.
To measure the association between intensive care unit (ICU) admission and both hospital and long-term mortality, separate from the effect of hospital admission alone. ⋯ After controlling for the effect of hospital admission, admission to ICU has minimal independent effect on mortality after discharge.
-
Critical care medicine · Mar 2002
Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables.
To evaluate diagnostic and prognostic values of C-reactive protein (CRP) dosage in critically ill patients. ⋯ CRP in combination with SIRS was useful to diagnose infection in ICU patients; a CRP decrease > or = 50 mg/L between admission and day 4 was the best predictor of recovery.
-
Critical care medicine · Mar 2002
Extracorporal life support for pulmonary hemorrhage in children: a case series.
To examine the use and outcome of extracorporeal life support in children with severe respiratory failure caused by pulmonary hemorrhage. ⋯ Extracorporeal life support is not contraindicated in patients with severe respiratory failure with associated pulmonary hemorrhage and may be a life-sustaining supportive therapy.