Critical care : the official journal of the Critical Care Forum
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Editorial Comment
A protocol guided by transpulmonary thermodilution and lactate levels for resuscitation of patients with severe burns.
Over-resuscitation is deleterious in many critically ill conditions, including major burns. For more than 15 years, several strategies to reduce fluid administration in burns during the initial resuscitation phase have been proposed, but no single or simple parameter has shown superiority. ⋯ The authors' results confirm that resuscitation can be achieved with below-normal levels of preload but at the price of a fluid administration greater than predicted by the Parkland formula (2 to 4 mL/kg per% burn). The classic approach based on an adapted Parkland equation may still be the simplest until further studies identify the optimal bundle of resuscitation goals.
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Clinical Trial Observational Study
Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients receiving enteral nutrition.
Malnutrition is a frequent problem associated with detrimental clinical outcomes in critically ill patients. To avoid malnutrition, most studies focus on the prevention of inadequate nutrition delivery, whereas little attention is paid to the potential role of exocrine pancreatic insufficiency (EPI). In this trial, we aim to evaluate the prevalence of EPI and identify its potential risk factors in critically ill adult patients without preexisting pancreatic diseases. ⋯ More than 50% of critically ill adult patients without primary pancreatic diseases had EPI, and nearly one-fifth of them had severe EPI. The risk factors for EPI included shock, sepsis, diabetes, cardiac arrest, hyperlactacidemia, invasive mechanical ventilation and haemodialysis.
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Plasma levels of cell-free hemoglobin are associated with mortality in patients with sepsis; however descriptions of independent associations with free hemoglobin and free heme scavengers, haptoglobin and hemopexin, are lacking beyond their description as acute phase reactants. We sought to determine the association of plasma levels of endogenous free hemoglobin and haptoglobin and hemopexin with in-hospital mortality in adults with sepsis. ⋯ In critically ill patients with sepsis, elevated plasma levels of haptoglobin were associated with a decreased risk of in-hospital mortality and this association was independent of confounders. Increased haptoglobin may play a protective role in sepsis patients who have elevated levels of circulating cell-free hemoglobin beyond its previous description as an acute phase reactant.
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Randomized Controlled Trial Multicenter Study
Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study.
Several single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG). ⋯ This multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.
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Acute respiratory failure is a dominant feature of critical illness. In this review, we discuss 17 studies published last year in Critical Care. The discussion focuses on articles on several topics: respiratory monitoring, acute respiratory distress syndrome, noninvasive ventilation, airway management, secretion management and weaning.