Critical care : the official journal of the Critical Care Forum
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The study by Wassenberg and colleagues shows that rapid diagnostic testing, although not cost-saving, reduces the number of unnecessary isolation days at ICU admission. Here, the strengths and limitations and the usefulness of rapid diagnostic testing are discussed from the collective and individual perspectives.
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Comparative Study
Hypoxia-inducible factor (HIF1α) gene expression in human shock states.
Hypoxia-inducible factor-1 (HIF1) controls the expression of genes involved in the cellular response to hypoxia. No information is available on its expression in critically ill patients. Thus, we designed the first clinical study in order to evaluate the role of HIF1α as a prognosis marker in patients with shock. ⋯ The present study is the first to demonstrate the increased expression of HIF1α in patients with shock. Further studies are needed to clarify the potential association with outcome. Our findings reinforce the value of monitoring plasma lactate levels to guide the treatment of shock.
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Observational Study
Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept.
Biofilm in endotracheal tubes (ETT) of ventilated patients has been suggested to play a role in the development of ventilator-associated pneumonia (VAP). Our purpose was to analyze the formation of ETT biofilm and its implication in the response and relapse of VAP. ⋯ Airway bacterial colonization and biofilm formation on ETTs are early and frequent events in ventilated patients. There is microbiological continuity between airway colonization, biofilm formation and VAP development. Biofilm stands as a pathogenic mechanism for microbial persistence, and impaired response to treatment in VAP.
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Letter Case Reports
Rapid detection of recurrent intraventricular hemorrhage by ultrasound in a multiple trauma patient who had undergone craniectomy.
Ultrasound may be a useful tool to evaluate intracranial abnormalities in critically ill patients undergoing decompressive craniectomy. We present a multiple trauma patient who had undergone craniectomy and in whom recurrent intraventricular hemorrhage and patterns of cerebral blood flow were rapidly detected by ultrasound.
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Pocket ultrasound devices have recently been developed and may be particularly useful for emergency assessment. These devices can be stored in a pocket but share only some technical features with conventional echocardiographic machines. ⋯ In this issue, a trial compares a pocket ultrasound device with a conventional echocardiographic machine for focused echocardiography in patients admitted to the emergency department. This commentary will put these findings into perspective.