Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Review Meta Analysis
Does Hypomagnesemia Impact on the Outcome of Patients Admitted to the Intensive Care Unit? A Systematic Review and Meta-Analysis.
Hypomagnesemia is commonly seen but frequently overlooked in critically ill patients in intensive care unit (ICU). However, the strength and consistency of the effect of hypomagnesemia on outcomes in critically ill patients remain controversial. In this report, we performed a systematic review and meta-analysis to evaluate the association of serum magnesium level with prognosis of critically ill patients upon admission to the ICU. ⋯ Length of ICU stay was also higher in the hypomagnesemia group (RR 1.85; 95% CI 0.43- 3.26; P = 0.01). Collectively, our data indicated that hypomagnesemia appears associated with greater risk of mortality, sepsis, mechanical ventilation, and the length of ICU stay in patients admitted to ICU. The role of magnesium therapy for improving outcomes in critically ill patients is needed to further study.
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Sepsis is the leading cause of death among critically ill patients and natural killer T (NKT) cell activation is essential to induce inflammatory cytokine cascade in sepsis. However, little is known about what regulates the NKT cell function during sepsis. Herein, we showed that T-cell immunoglobulin and mucin domain 3 (Tim-3) expression in NKT cells is elevated in experimental mice during sepsis. ⋯ Administration of α-lactose to block Tim-3 signaling pathway significantly improved the survival of septic mice, concomitant with reduced IL-12 production by dendritic cells, reduced Tim-3 expression, prevented NKT cell apoptosis, and attenuated production of inflammatory cytokines. Collectively, Tim-3 signaling in NKT cells plays a critical role in the immunopathogenesis of sepsis. Thus, α-lactose could be a promising immunomodulatory agent in the treatment of sepsis.
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Our objective was to determine how circulatory failure develops following systemic administration of potassium cyanide (KCN). We used a noninhaled modality of intoxication, wherein the change in breathing pattern would not influence the diffusion of CN into the blood, akin to the effects of ingesting toxic levels of CN. In a group of 300 to 400 g rats, CN-induced coma (CN i.p., 7 mg/kg) produced a central apnea within 2 to 3 min along with a potent and prolonged gasping pattern leading to autoresuscitation in 38% of the animals. ⋯ It is concluded that circulatory failure can develop as a direct consequence of CN-induced apnea but in a narrow range of exposure. In this "low" range, maintaining pulmonary gas exchange after exposure, through mechanical ventilation (or spontaneous gasping), can reverse cardiac depression and restore spontaneous breathing. At higher level of intoxication, cardiac depression is to be treated as a specific and spontaneously irreversible consequence of CN exposure, leading to a PEA.
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We evaluated the mean platelet volume (MPV) to platelet ratio to determine its significance as a prognostic marker for early mortality in critically ill patients with suspected sepsis receiving early goal-directed therapy (EGDT). ⋯ In our study, MPV or platelet count alone did not predict shock and 28-day mortality in patients with severe sepsis receiving EGDT. However, the MPV/platelet ratio at ED admission and on day 1 is a promising prognostic marker for 28-day mortality in patients with severe sepsis.