Critical care : the official journal of the Critical Care Forum
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The ability of the isolated lung tissue to take up glucose and to release lactate is potentially similar to that of other body tissues. Nonetheless, when lung lactate exchange was assess in vivo in normal humans, no measurable lactate production could be detected. ⋯ Potential mechanisms of lactate production by the injured lung may include not only the onset of anaerobic metabolism in hypoxic zones, but also direct cytokine effects on pulmonary cells and an accelerated glucose metabolism in both the parenchymal and the inflammatory cells infiltrating lung tissue. In addition, as skeletal muscle, lung tissue may show metabolic adaptations in response to systemic mediators and may contribute to the systemic metabolic response to severe illness even in the absence of direct tissue abnormalities.
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Randomized Controlled Trial Clinical Trial
Quality of life effects of antithrombin III in sepsis survivors: results from the KyberSept trial [ISRCTN22931023].
Treatment of sepsis is aimed at increasing both the duration and quality of survival. A long-term focus on quality of life (QoL) in clinical trial evaluations of sepsis care should be a priority. ⋯ The present study represents the first attempt to evaluate patient QoL over a relatively long period in a large, randomized, placebo-controlled sepsis trial. Over a 90-day period, survivors of severe sepsis receiving antithrombin III experienced significant improvements as compared with placebo on several attributes of QoL. In conclusion, the present study demonstrated that clinical improvements over an extended time period with antithrombin III were complemented by improvements in QoL, particularly in social and psychologic functioning, in many patients.
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Lipopolysaccharide (endotoxin) from the cell wall of Gram-negative bacteria is a potent trigger for the release of host-derived inflammatory mediators. The relationship between endotoxaemia, Gram-negative infection and the clinical syndrome of sepsis has been difficult to establish, in part because of the limitations of available endotoxin assays. ⋯ Endotoxaemia is associated with Gram-negative infection from any source, and with a diagnosis of sepsis and leukocytosis. These correlations were not apparent using the LAL method. The EAA may be a useful diagnostic tool for the investigation of invasive Gram-negative infection and incipient sepsis.
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Despite decades of resuscitating patients with intravenous fluids in intensive care units, it is somewhat surprising that very little consensus exists regarding the type of fluid physicians should choose. Factors that influence decisions are often local culture or politics, hospital administrators, history (i.e. 'I've always done it this way') and budgets, as opposed to strong evidence. ⋯ As such, in the future, clinicians will need to consider other factors when making their decision. In addition, large-scale quality randomised studies are desperately needed to guide clinicians.
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A growing body of evidence indicates that survivors of intensive care have an impaired quality of life. It is not entirely clear from the available literature whether this impairment is a complication of critical illness or a complication of therapy. There is little evidence to guide physicians to treatments in the intensive care unit that will minimize the effects of critical illness on these sequelae. Although the study by Rublee and colleagues in this issue of Critical Care provides little clinically useful information about the effects of antithrombin III on quality of life, it provides some insight into the challenges that investigators will encounter as we try to incorporate these outcomes into studies of critical illness.