Articles: function.
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Randomized Controlled Trial
Impact of Early Mobilization on Glycemic Control and ICU-Acquired Weakness in Critically Ill Patients Who Are Mechanically Ventilated.
ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically ill patients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known. ⋯ The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT.
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Critical care medicine · Sep 2014
Arterial Blood Pressure and Neurological Outcome After Resuscitation From Cardiac Arrest.
Guidelines for post-cardiac arrest care recommend blood pressure optimization as one component of neuroprotection. Although some retrospective clinical studies suggest that postresuscitation hypotension may be harmful, and laboratory studies suggest that a postresuscitation hypertensive surge may be protective, empirical data are few. In this study, we prospectively measured blood pressure over time during the postresuscitation period and tested its association with neurologic outcome. ⋯ We found that time-weighted average mean arterial pressure was associated with good neurologic outcome at a threshold of mean arterial pressure greater than 70 mm Hg.
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We present the case of a 20-year-old woman with a history of hypoplastic left heart syndrome, D-transposition of the great arteries, and mitral/pulmonary valve atresia without surgical palliation, who was admitted with persistent atrial flutter/fibrillation and worsening cardiac function from amiodarone-induced thyrotoxicosis. Despite maximal medical therapy, she continued to have uncontrolled thyrotoxicosis and underwent successful emergent thyroidectomy under general anesthesia. With advances in the treatment of congenital heart disease, more patients are surviving to adulthood and require emergent noncardiac surgery. Therefore, anesthesiologists must understand the principles for managing patients with congenital heart disease and how the patient's physiology may affect the anesthetic plan.
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Critical care medicine · Sep 2014
Circulating Immature Granulocytes With T-Cell Killing Functions Predict Sepsis Deterioration.
Primary objective was to identify leukocyte subsets that could predict the early evolution of sepsis at 48 hours (i.e., deterioration or stability/improvement). Secondary objectives were to evaluate the prognostic value of leukocyte subsets on mortality and immunosuppressive properties of immature granulocytes. ⋯ Circulating immature granulocytes predicted early sepsis deterioration and were enriched in myeloid-derived suppressor cells which could be responsible for immunosuppression through the induction of T-cell lymphopenia.
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Observational Study
Assessing the bowel function of critically ill children: a pilot study.
To describe the bowel function of critically ill children. ⋯ Critically unwell children needing more than 24 hours of intensive care have a state of non-defecation for most of the time, with formed stools being rare. Further observational studies will better define bowel function in critically unwell children.