Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Contrast-enhanced ultrasound: a new vision of microcirculation in the intensive care unit.
To gain new insights into renal perfusion and pathogenesis of acute kidney injury in intensive care unit (ICU) patients, we need new techniques to evaluate renal microcirculation. In addition, a bedside technique applicable in the ICU could be extremely useful for physicians to adjust the optimal therapeutic/preventive modalities for kidney perfusion in each patient. ⋯ In addition, CEUS derived-parameters suggest a decrease in renal perfusion occurring within 24 hours of surgery in patients at risk of acute kidney injury. This study opens up new possibilities for the assessment of cortical renal microcirculation in ICU patients.
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Comparative Study Observational Study
Characteristics and outcomes of culture-negative versus culture-positive severe sepsis.
Culture-negative sepsis is a common but relatively understudied condition. The aim of this study was to compare the characteristics and outcomes of culture-negative versus culture-positive severe sepsis. ⋯ Significant differences between culture-negative and culture-positive sepsis are identified, with the former group having fewer comorbidities, milder severity of illness, shorter hospitalizations, and lower mortality.
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Editorial Comment
Identifying patients at risk for augmented renal clearance in the ICU - limitations and challenges.
Augmented renal clearance (ARC) is an important determinant of antibiotic exposure in critically ill patients, and identifying patients at risk is therefore an important goal. There is a growing body of evidence that a younger patient with a low to moderate degree of organ dysfunction typically is at risk of ARC and therefore decreased exposure to renally eliminated antibiotics. Mechanisms potentially involved, such as increased cardiac output, have, however, not been identified as appropriate surrogate markers, and the search for suitable alternatives to readily identify patients with ARC continues.
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Hypercapnic acidosis (HCA) that accompanies lung-protective ventilation may be considered permissive (a tolerable side effect), or it may be therapeutic by itself. Cardiovascular effects may contribute to, or limit, the potential therapeutic impact of HCA; therefore, a complex physiological study was performed in healthy pigs to evaluate the systemic and organ-specific circulatory effects of HCA, and to compare them with those of metabolic (eucapnic) acidosis (MAC). ⋯ MAC preferentially affects the pulmonary circulation, whereas HCA affects the pulmonary, systemic, and regional circulations. The cardiac contractile function was reduced, but the cardiac output was maintained (MAC), or even increased (HCA). The increased ventricular stroke work per minute revealed an increased work demand placed by acidosis on the heart.
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Comparative Study
Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit.
Tracheal intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU intubations. ⋯ In the medical ICU, video laryngoscopy resulted in higher first attempt and ultimate intubation success rates and improved grade of laryngoscopic view while reducing the esophageal intubation rate compared to direct laryngoscopy.