Articles: function.
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J Clin Monit Comput · Feb 2015
Case ReportsRepeated early hemofiltration filters clotting and heparin-induced thrombocytopenia in ICU.
Repeated early hemofiltration filter clotting are real thrombotic events. Diagnosis of heparin-induced thrombocytopenia (HIT) in this setting in ICU remains difficult. ⋯ Despite a 4T's score of three for the two patients and persistent early hemofiltration clotting filters, functional tests for HIT antibodies (heparin induced platelet activation assay and serotonin release assay) were positive, permitting the diagnosis of HIT in both patients. We suggest that the occurrence of repeated, rapid (within 6 h) hemofiltration filter clotting should score as two points for "Thrombosis" in the 4T's scoring system, thereby increasing the pretest probability for HIT in this clinical situation.
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Routine lung function and respiratory muscle testing are recommended in children with neuromuscular disease (NMD), but these tests are based on noninvasive volitional maneuvers, such as the measurement of lung volumes and maximal static pressures, that young children may not always be able to perform. The realization of simple natural maneuvers such as a sniff or a cough, and the measurement of esophageal and gastric pressures during spontaneous breathing can add valuable information about the strength and endurance of the respiratory muscles in young children. Monitoring respiratory muscles in children with NMD may improve understanding of the natural history of NMD and the evaluation of disease severity. It may assist and guide clinical management and it may help the identification and selection of optimal end points, as well as the most informative parameters and patients for clinical trials.
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Critical care medicine · Feb 2015
Dysphagia-A Common, Transient Symptom in Critical Illness Polyneuropathy: A Fiberoptic Endoscopic Evaluation of Swallowing Study.
Critical illness polyneuropathy is a common disorder in the neurological ICU. Dysphagia is well known to deteriorate outcome in the ICU. The prevalence of dysphagia in critical illness polyneuropathy is not known. The aim of this study was to evaluate the prevalence of dysphagia in critical illness polyneuropathy using fiberoptic endoscopic evaluation of swallowing. ⋯ Dysphagia is frequent among patients with critical illness polyneuropathy treated in the ICU. Old age, chronic obstructive pulmonary disease, the mode of mechanical ventilation, the prevalence of tracheal tubes, and behavioral "learned nonuse" may all be contributing factors for the development of dysphagia in critical illness polyneuropathy. Complete recovery occurs in a high percentage of affected individuals within 4 weeks.
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Minerva anestesiologica · Feb 2015
Osteopontin induces soluble urokinase-type plasminogen activator receptor production and release.
Osteopontin (OPN) and soluble urokinase plasminogen activator receptor (suPAR) have been proposed as markers of disease severity and risk-stratification in infection and inflammation. In breast cancer, OPN and the membrane bound form of urokinase plasminogen activator receptor (uPAR) are functionally related, as OPN-induced cell migration depends on uPAR triggering by urokinase plasminogen activator (uPA). The aim of this study was to prospectively evaluate the kinetic of OPN and suPAR blood levels in patients developing septic shock (SS) compared to those not developing SS, and to investigate the relationships between these two biomarkers in immune cells in vitro. ⋯ These data suggest that OPN is partly responsible for the increased plasma levels of suPAR and might be a valuable tool to predict the occurrence of septic shock.
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Anesthesia and analgesia · Feb 2015
The Effects of Exogenous Surfactant Treatment in a Murine Model of Two-Hit Lung Injury.
Because pulmonary endogenous surfactant is altered during acute respiratory distress syndrome, surfactant replacement may improve clinical outcomes. However, trials of surfactant use have had mixed results. We designed this animal model of unilateral (right) lung injury to explore the effect of exogenous surfactant administered to the injured lung on inflammation in the injured and noninjured lung. ⋯ Exogenous surfactant administration to an acid-injured right lung improved gas exchange and whole respiratory system compliance. However, markers of inflammation increased in the right (injured) lung, although this result was not found in the left (uninjured) lung. These data suggest that the mechanism by which surfactant improves lung function may involve both uninjured and injured alveoli.