07 Oct 06
Posted in General, Hypothermia, Pneumonia at 10:19 by Laci
By Cr Bouch, G Williams
Critical Care 2006, 10:167
Pneumonia (hospital-acquired and community-acquired) is commonly encountered in intensive care. Several papers recently published on this subject have shed more light on different aspects of this important topic. Hypothermia has been shown to improve post-arrest outcome, but how often do we use it? And finally, several papers have recently appeared in the journals related to the admission of the elderly to the critical care area and their outcome.
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Posted in Diabetes, Organ failure at 10:18 by Laci
By K Slynkova, DM Mannino, GS Martin, RS Morehead, DE Doherty
Critical Care 2006, 10:R137
Several studies have shown a correlation between body mass index (BMI) and both the development of critical illness and adverse outcomes in critically ill patients. The goal of our study was to examine this relationship prospectively with particular attention to the influence of concomitant diabetes mellitus (DM).
Methods
We analyzed data from 15,408 participants in the Atherosclerosis Risk in Communities (ARIC) study for this analysis. BMI and the presence of DM were defined at baseline. We defined ‘acute organ failure’ as those subjects who met a standard definition with diagnostic codes abstracted from hospitalization records. Outcomes assessed included the following: risk of the development of acute organ failure within three years of the baseline examination; in-hospital death while ill with acute organ failure; and death at three years among all subjects and among those with acute organ failure.
Results
At baseline, participants with a BMI of at least 30 were more likely than those in lower BMI categories to have DM (22.4% versus 7.9%, p < 0.01). Overall, BMI was not a significant predictor of developing acute organ failure. The risk for developing acute organ failure was increased among subjects with DM in comparison with those without DM (2.4% versus 0.7%, p < 0.01). Among subjects with organ failure, both in-hospital mortality (46.5% versus 12.2%, p < 0.01) and 3-year mortality (51.2% versus 21.1%, p < 0.01) was higher in subjects with DM.
Conclusion
Our findings suggest that obesity by itself is not a significant predictor of either acute organ failure or death during or after acute organ failure in this cohort. However, the presence of DM, which is related to obesity, is a strong predictor of both acute organ failure and death after acute organ failure.
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Posted in Inotropic support at 10:10 by Laci
By W Frishman
Critical Care Medicine 2003;31(9):2408-2409
The life expectancy of patients with congestive heart failure is shortened or, at best, unchanged by long-term exposure to currently available positive inotropic agents (1). All positive inotropic agents currently available enhance myocardial contractility by increasing intracellular calcium concentration. Increased intracellular calcium may be caused by an increase in the intracellular concentration of cyclic adenosine monophosphate, which can be caused by ß-adrenergic stimulation or by decreasing the catabolism of cyclic adenosine monophosphate via phosphodiesterase inhibition (2). Increasing intracellular calcium also can promote after-potential depolarizations and, thereby, ventricular tachyarrhythmias and sudden death……
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Posted in ALI/ARDS, Inotropic support at 10:09 by Laci
By A Morelli, JL Teboul, Sm Maggiore, A Vieillard-Baron,M Rocco, G Conti,A De Gaetano,U Picchini, A Orecchioni, I Carbone, L Tritapepe, P Pietropaoli, M Westphal
Critical Care Medicine 2006;34(9):2287-2293
Acute respiratory distress syndrome (ARDS) is frequently associated with increased pulmonary vascular resistance and thus with systolic load of the right ventricle. We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS.
Design
Prospective, randomized, placebo-controlled, pilot study.
Setting
Twenty-two-bed multidisciplinary intensive care unit of a university hospital.
Patients
Thirty-five patients with ARDS in association with septic shock.
Interventions
Patients were randomly allocated to receive a 24-hr infusion of either levosimendan 0.2 ug/kg/min (n = 18) or placebo (n = 17). Data from right heart catheterization, cardiac magnetic resonance, arterial and mixed venous oxygen tensions and saturations, and carbon dioxide tensions were obtained before and 24 hrs after drug infusion.
Measurements and Main Results
At a mean arterial pressure between 70 and 80 mm Hg (sustained with norepinephrine infusion), levosimendan increased cardiac index (from 3.8 +/- 1.1 to 4.2 +/- 1.0 L/min/m2) and decreased mean pulmonary artery pressure (from 29 +/- 3 to 25 +/- 3 mm Hg) and pulmonary vascular resistance index (from 290 +/- 77 to 213 +/- 50 dynes/s/cm5/m2; each p < .05). Levosimendan also decreased right ventricular end-systolic volume and increased right ventricular ejection fraction (p < .05). In addition, levosimendan increased mixed venous oxygen saturation (from 63 +/- 8 to 70 +/- 8%; p < .01).
Conclusions
This study provides evidence that levosimendan improves right ventricular performance through pulmonary vasodilator effects in septic patients with ARDS. A large multiple-center trial is needed to investigate whether levosimendan is able to improve the overall prognosis of patients with sepsis and ARDS.
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