Critical care : the official journal of the Critical Care Forum
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Sepsis is the leading cause of admission to critical care units worldwide, with increasing research and publications reflecting this. Tight control of the blood glucose concentration can reduce morbidity and mortality but the obtained values can be influenced by the method of measurement. Increasing awareness of interactions with patients and relatives can make or break relationships between staff and patients/families.
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Editorial Comment
Barbiturates for the treatment of intracranial hypertension after traumatic brain injury.
In their article on the use of barbiturates for the treatment of intracranial hypertension after traumatic brain injury, Perez-Barcena and colleagues conclude that thiopental was more effective than pentobarbital in decreasing intracranial pressure. Here we discuss the limitations of this study and review areas of controversy surrounding barbiturate use in neurocritical care.
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Editorial Comment
An anti-inflammatory role for tranexamic acid in cardiac surgery?
Pro- and anti-inflammatory cytokines are elevated after cardiac surgery. The control of the release of these major paracrine proteins is becoming clearer and they have been shown to be involved in the activation of the coagulation/fibrinolysis pathway, among other cascades. The association of a predominance of pro-inflammatory cytokines with morbidity in some patients, particularly following cardiac surgery, is well described but still incompletely understood. Clinical studies elucidating how clinicians may influence this cytokine release directly will improve our knowledge of the processes involved and could ultimately show benefit in better outcomes for patients.
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Editorial Comment
Insulin, intracerebral glucose and bedside biochemical monitoring utilizing microdialysis.
Following subarachnoid hemorrhage, hyperglycemia is strongly associated with complications and with impaired neurological recovery. Targeted insulin therapy for glycemic control might, on the contrary, have harmful effects by causing too low cerebral glucose levels. The study published by Schlenk and colleagues in the previous issue of Critical Care shows that insulin caused a significant decrease in the interstitial cerebral glucose concentration although the blood glucose level remained unaffected. Since several studies utilizing various analytical techniques have shown that cerebral blood flow and cerebral glucose uptake and metabolism are insulin-independent processes, the observation remains unexplained.
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Editorial Comment
Corticosteroids for community-acquired pneumonia: time to act!
The use of corticosteroids for the treatment of community-acquired pneumonia has been reported for almost 50 years. A recent systematic analysis of the relevant literature suggested that corticosteroids reduce the critical illness associated with community-acquired pneumonia. There is little doubt that a prolonged administration of a moderate dose of corticosteroids may alleviate the systemic inflammatory response and subsequent organ dysfunction in severe infection. Whether these favorable effects on morbidity may translate into better survival and quality of life needs to be addressed in additional adequately powered randomized controlled trials.