Critical care : the official journal of the Critical Care Forum
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Management of the early stage of sepsis is a critical issue. As part of it, infection control including appropriate antibiotic therapy administration should be prompt. However, microbiological findings, if any, are generally obtained late during the course of the disease. The potential interest of procalcitonin (PCT) as a way to assess the clinical efficacy of the empirical antibiotic therapy was addressed in the present study. ⋯ In our study in an ICU, appropriateness of the empirical antibiotic therapy and the overall survival were associated with a greater decline in PCT between D2 and D3. Further studies are needed to assess the utility of the daily monitoring of PCT in addition to clinical evaluation during the early management of sepsis.
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Estimation of the diameter and cross-sectional area of the internal jugular veins in adult patients.
Unawareness of an asymmetry between the right and left internal jugular vein (IJV) and methodological pitfalls in previous studies raise concerns about such asymmetry. Hence the aim of this prospective non-interventional study was to validate the hypothesis that right IJV diameter is greater than those of left IJV and to determine the cross-sectional area of the IJVs using computed tomography (CT)-scans and original automatic software. ⋯ In a general population of adult outpatients, the diameter and cross-sectional area of the right IJV were significantly greater than those of the left IJV. This could be an additional argument to prefer right over left IJV cannulation.
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Several recent studies have shown that a positive fluid balance in critical illness is associated with worse outcome. We tested the effects of moderate vs. high-volume resuscitation strategies on mortality, systemic and regional blood flows, mitochondrial respiration, and organ function in two experimental sepsis models. ⋯ High-volume resuscitation including HES in experimental peritonitis and endotoxemia increased mortality despite better initial hemodynamic stability. This suggests that the strategy of early fluid management influences outcome in sepsis. The high mortality was not associated with reduced mitochondrial complex I- or II-dependent muscle and hepatic respiration.
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The present study was performed to test a new software version of the FloTrac/Vigileo using head-up-head-down tilting in post-cardiac surgery patients. Impressive improvements in Bland and Altman limits of agreement from 37.5% to 21.6% were recorded. The results, however could be attributed to a failure to produce a wide enough range of test circulatory conditions. A more rigorous test of performance is needed before any real conclusion concerning use of the FloTrac/Vigileo in clinical practice can be made.
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Current evidence regarding whether the staffing of intensive care units (ICUs) with a trained Intensivist benefits patient outcomes is discordant. We sought to determine whether, among certified Intensivists, base specialty of training could contribute to variation in practice patterns and patient outcomes in ICUs. ⋯ Intensivists' base specialty of training is associated with practice pattern variations. This may contribute to differences in processes and outcomes of patient care.