22 Sep 07
Posted in BNP, Critical Care at 18:23 by Laci
By C Mueller
Crit Care Med 2007;35:2438-2439
B-type natriuretic peptides (BNP and NT-pro-BNP) are quantitative markers of cardiac stress and heart failure, summarizing the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. They have been shown to be extremely helpful in the diagnosis and prognosis of heart failure, particularly in the emergency department. As the diagnostic dilemmas in the intensive care unit (ICU) are often as challenging as in the emergency department, recent studies have begun to evaluate whether the use of BNP might also be helpful in the ICU. Major differences in patient characteristics, disease severity, comorbidity, resources available for the individual patient, and therapies applied between the ICU and the emergency department require that the potential clinical use of BNP in the ICU be defined by specific ICU studies.
The use of a biomarker to detect heart failure in the ICU is based on the observation that heart failure is common in the ICU and on the assumption that the detection of heart failure in the ICU allows the initiation of specific heart failure therapy or changes in patient management that ultimately might improve patient morbidity and mortality. In critically ill patients, even small improvements in management might have the potential to improve patient outcome.
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Posted in BNP, Critical Care at 18:20 by Laci
By B Meyer, M Huelsmann, P Wexberg, GD Karth, R Berger, D Moertl, T Szekeres, R Pacher, G Heinz, Gottfried
Crit Care Med 2007;35:2268-2273
Natriuretic peptides emerged during recent years as potent prognostic markers in patients with heart failure and acute myocardial infarction. In addition, natriuretic peptides show strong predictive value in patients with pulmonary embolism, sepsis, renal failure, and shock. The present study tests the prognostic information of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in an unselected cohort of critically ill patients.
Design
Prospective, observational study.
Setting
A tertiary intensive care unit in a university hospital.
Patients
A total of 289 consecutive patients admitted to the intensive care unit during a 16-month period with the following data: age 64 +/- 14 yrs, male n = 191, Simplified Acute Physiology Score II of 52 +/- 24, mechanical ventilation n = 180 (62%), vasopressors n = 179 (62%), renal failure n = 24 (8%).
Interventions
None.
Measurements and Main Results
Plasma NT-pro-BNP samples (Roche Diagnostics) were obtained on intensive care unit admission. Data are given as median [range]. Intensive care unit survivors had significantly lower NT-pro-BNP values compared with intensive care unit nonsurvivors (3394 [24-35,000] vs. 6776 [303-35,000] pg/mL, survivors vs. nonsurvivors, respectively, p = .001). Hospital survivors were characterized by significantly lower NT-pro-BNP values (2656 [24-35,000] vs. 8390 [303-35,000] pg/mL, survivors vs. nonsurvivors, respectively, p = .001). NT-pro-BNP levels were not significantly different in patients with primary cardiac diagnosis compared with those with a noncardiac admission diagnosis (4794 [26-35,000], n = 202 vs. 3349 [24-35,000], n = 87, cardiac vs. noncardiac, respectively, p = .28). In a logistic regression model, Simplified Acute Physiology Score II and NT-pro-BNP were independently associated with hospital survival ([chi]2 = 35.6, p = .0001 and [chi]2 = 11.3, p = .0008, Simplified Acute Physiology Score II and NT-pro-BNP, respectively). Areas under the receiver operating characteristic curves of NT-pro-BNP and Simplified Acute Physiology Score II were not statistically significant different regarding the prediction of outcome.
Conclusions
NT-pro-BNP on admission is an independent prognostic marker of outcome in an unselected cohort of critically ill patients. A single measurement of NT-pro-BNP might facilitate triage of emergency and intensive care unit patients.
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Posted in Mobile phones at 18:16 by Laci
By Erik Jan van Lieshout, Sabine N van der Veer, Reinout Hensbroek, Johanna C Korevaar, Margreeth B Vroom and Marcus J Schultz
Critical Care 2007, 11:R98
The aim of the study was to assess and classify incidents of electromagnetic interference (EMI) by second-generation and third-generation mobile phones on critical care medical equipment.
Methods
EMI was assessed with two General Packet Radio Service (GPRS) signals (900 MHz, 2 W, two different time-slot occupations) and one Universal Mobile Telecommunications System (UMTS) signal (1,947.2 MHz, 0.2 W), corresponding to maximal transmit performance of mobile phones in daily practice, generated under controlled conditions in the proximity of 61 medical devices. Incidents of EMI were classified in accordance with an adjusted critical care event scale.
Results
A total of 61 medical devices in 17 categories (27 different manufacturers) were tested and demonstrated 48 incidents in 26 devices (43%); 16 (33%) were classified as hazardous, 20 (42%) as significant and 12 (25%) as light. The GPRS-1 signal induced the most EMI incidents (41%), the GRPS-2 signal induced fewer (25%) and the UMTS signal induced the least (13%; P < 0.001). The median distance between antenna and medical device for EMI incidents was 3 cm (range 0.1 to 500 cm). One hazardous incident occurred beyond 100 cm (in a ventilator with GRPS-1 signal at 300 cm).
Conclusion
Critical care equipment is vulnerable to EMI by new-generation wireless telecommunication technologies with median distances of about 3 cm. The policy to keep mobile phones ’1 meter’ from the critical care bedside in combination with easily accessed areas of unrestricted use still seems warranted.
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Posted in Nutrition, Sepsis at 18:12 by Laci
By Michael J O’Leary, Aiqun Xue, Christopher J Scarlett, Andre Sevette, Anthony J Kee and Ross C Smith
Critical Care 2007, 11:R79
Early nutrition is recommended for patients with sepsis, but data are conflicting regarding the optimum route of delivery. Enteral nutrition (EN), compared with parenteral nutrition (PN), results in poorer achievement of nutritional goals but may be associated with fewer infections. Mechanisms underlying differential effects of the feeding route on patient outcomes are not understood, but probably involve the immune system and the anabolic response to nutrients. We studied the effect of nutrition and the route of delivery of nutrition on cytokine profiles, the growth hormone–insulin-like growth factor-1 (IGF-I) axis and a potential mechanism for immune and anabolic system interaction, the suppressors of cytokine signaling (SOCS), in rodents with and without sepsis.
Methods
Male Sprague–Dawley rats were randomized to laparotomy (Sham) or to cecal ligation and puncture (CLP), with postoperative saline infusion (Starve), with EN or with PN for 72 hours. Serum levels of IL-6 and IL-10 were measured by immunoassay, and hepatic expressions of cytokine-inducible SH2-containing protein, SOCS-2, SOCS-3, IGF-I and the growth hormone receptor (GHR) were measured by real-time quantitative PCR.
Results
IL-6 was detectable in all groups, but was only present in all animals receiving CLP-PN. IL-10 was detectable in all but one CLP-PN rat, one CLP-EN rat, approximately 50% of the CLP-Starve rats and no sham-operated rats. Cytokine-inducible SH2-containing protein mRNA was increased in the CLP-EN group compared with the Sham-EN group and the other CLP groups (P < 0.05). SOCS-2 mRNA was decreased in CLP-PN rats compared with Sham-PN rats (P = 0.07). SOCS-3 mRNA was increased with CLP compared with sham operation (P < 0.03). IGF-I mRNA (P < 0.05) and GHR mRNA (P < 0.03) were greater in the fed CLP animals and in the Sham-PN group compared with the starved rats.
Conclusion
In established sepsis, nutrition and the route of administration of nutrition influences the circulating cytokine patterns and expression of mRNA of SOCS proteins, GHR and IGF-I. The choice of the administration route of nutrition may influence cellular mechanisms that govern the response to hormones and mediators, which further influence the response to nutrients. These findings may be important in the design and analysis of clinical trials of nutritional interventions in sepsis in man.
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