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Critical Care: the Official Journal of the Critical Care Forum

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https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#1
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29137677/angiotensin-ii-in-vasodilatory-shock-lights-and-shadows
#2
LETTER
Elio Antonucci, Sara Agosta, Yasser Sakr
No abstract text is available yet for this article.
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29132435/vasculotide-reduces-pulmonary-hyperpermeability-in-experimental-pneumococcal-pneumonia
#3
Birgitt Gutbier, Xiaohui Jiang, Kristina Dietert, Carolin Ehrler, Jasmin Lienau, Paul Van Slyke, Harold Kim, Van C Hoang, Jason T Maynes, Daniel J Dumont, Achim D Gruber, Norbert Weissmann, Timothy J Mitchell, Norbert Suttorp, Martin Witzenrath
BACKGROUND: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide. Despite effective antimicrobial therapy, CAP can induce pulmonary endothelial hyperpermeability resulting in life-threatening lung failure due to an exaggerated host-pathogen interaction. Treatment of acute lung injury is mainly supportive because key elements of inflammation-induced barrier disruption remain undetermined. Angiopoietin-1 (Ang-1)-mediated Tie2 activation reduces, and the Ang-1 antagonist Ang-2 increases, inflammation and endothelial permeability in sepsis...
November 13, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29132411/an-isolated-elevation-in-blood-urea-level-is-not-uraemia-and-not-an-indication-for-renal-replacement-therapy-in-the-icu
#4
EDITORIAL
Jack Mackenzie, Bobby Chacko
The decision to initiate renal replacement therapy (RRT) and the optimal timing for commencement is a difficult decision faced by clinicians when treating acute kidney injury (AKI) in the intensive care setting. Without clinically significant ureamic symptoms or emergent indications (electrolyte abnormalities, volume overload) the timing of RRT initiation remains contentious and inconsistent across health providers. Current trends of initiating RRT in the ICU are often based on isolated blood urea levels without clear guidelines demonstrating an upper limit for treatment...
November 13, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29121983/early-psychological-screening-of-intensive-care-unit-survivors-a-prospective-cohort-study
#5
Anna Milton, Emily Brück, Anna Schandl, Matteo Bottai, Peter Sackey
BACKGROUND: A majority of patients survive their episode of critical illness but up to 30% of patients suffer from psychological problems such as post-traumatic stress, anxiety and depression in the year after intensive care unit (ICU) stay. A method to identify discharged patients at risk for adverse psychological outcome would be helpful in the triage for ICU follow-up and could enable early intervention. The aim of this study was to evaluate whether early screening with validated questionnaires after ICU discharge can identify patients at risk for symptoms of post-traumatic stress, anxiety and depression 3 months after ICU stay...
November 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29096688/does-enhanced-antibiotic-de-escalation-really-have-no-benefit-in-the-icu
#6
LETTER
Shingo Ohki, Shinichiro Ohshimo, Nobuaki Shime
No abstract text is available yet for this article.
November 2, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29096675/the-impact-of-sex-and-age-on-neurological-outcomes-in-out-of-hospital-cardiac-arrest-patients-with-targeted-temperature-management
#7
Sang Hoon Oh, Kyu Nam Park, Jeeyong Lim, Seung Pill Choi, Joo Suk Oh, In Soo Cho, Byung Kook Lee, Yong Hwan Kim, Young-Min Kim, Han Joon Kim, Chun Song Youn, Soo Hyun Kim
BACKGROUND: There are conflicting data regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients, and whether the specific sex advantage is age-specific remains unclear. We assessed the impact of the interactions between sex and age on the neurological outcomes of OHCA patients receiving targeted temperature management (TTM). METHODS: Data collected from 2007 to 2012 for a multicenter, registry-based study of the Korean Hypothermia Network were analyzed...
November 2, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29096674/icatibant-as-an-early-rescue-therapy-in-hypovolemic-shock-with-converting-enzyme-inhibitor-treatment
#8
LETTER
Hélène Charbonneau, Marie Buléon, Benoit Richard, Nicolas Mayeur
No abstract text is available yet for this article.
November 2, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29089038/the-impact-of-n-acetylcysteine-and-ascorbic-acid-in-contrast-induced-nephropathy-in-critical-care-patients-an-open-label-randomized-controlled-study
#9
Eleni Palli, Demosthenes Makris, John Papanikolaou, Grigorios Garoufalis, Irini Tsilioni, Paris Zygoulis, Epaminondas Zakynthinos
BACKGROUND: The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients. METHODS: This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study...
October 31, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29089025/implementation-of-sepsis-bundles-in-public-hospitals-in-brazil-a-prospective-study-with-heterogeneous-results
#10
Flavia Ribeiro Machado, Elaine Maria Ferreira, Pierre Schippers, Ilusca Cardoso de Paula, Letícia Sandre Vendrame Saes, Francisco Ivanildo de Oliveira, Paula Tuma, Wilson Nogueira Filho, Felipe Piza, Sandra Guare, Cláudia Mangini, Gustavo Ziggiatti Guth, Luciano Cesar Pontes Azevedo, Flavio Geraldo Resende Freitas, Jose Luiz Gomes do Amaral, Nacime Salomão Mansur, Reinaldo Salomão
BACKGROUND: Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. METHODS: We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality...
October 31, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29078796/lactate-and-stepwise-lactate-kinetics-can-be-used-to-guide-resuscitation
#11
LETTER
Xiang Zhou, Dawei Liu, Longxiang Su
No abstract text is available yet for this article.
October 27, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29073934/noninvasive-ventilation-in-hypercapnic-chronic-obstructive-pulmonary-disease
#12
LETTER
Silvio A Ñamendys-Silva
No abstract text is available yet for this article.
October 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29073930/functional-evaluation-of-sublingual-microcirculation-indicates-successful-weaning-from-va-ecmo-in-cardiogenic-shock
#13
Sakir Akin, Dinis Dos Reis Miranda, Kadir Caliskan, Osama I Soliman, Goksel Guven, Ard Struijs, Robert J van Thiel, Lucia S Jewbali, Alexandre Lima, Diederik Gommers, Felix Zijlstra, Can Ince
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters...
October 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29061152/individualized-perfusion-targets-in-hypoxic-ischemic-brain-injury-after-cardiac-arrest
#14
Mypinder S Sekhon, Donald E Griesdale
Secondary injury is a major determinant of outcome in hypoxic ischemic brain injury (HIBI) after cardiac arrest and may be mitigated by optimizing cerebral oxygen delivery (CDO2). CDO2 is determined by cerebral blood flow (CBF), which is dependent upon mean arterial pressure (MAP). In health, CBF remains constant over the MAP range through cerebral autoregulation. In HIBI, the zone of intact cerebral autoregulation is narrowed and varies for each patient. Maintaining MAP within the intact autoregulation zone may mitigate ischemia, hyperemia and secondary injury...
October 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058634/three-dimensional-ultrastructure-of-capillary-endothelial-glycocalyx-under-normal-and-experimental-endotoxemic-conditions
#15
Hideshi Okada, Genzou Takemura, Kodai Suzuki, Kazumasa Oda, Chihiro Takada, Yasuaki Hotta, Nagisa Miyazaki, Akiko Tsujimoto, Isamu Muraki, Yoshiaki Ando, Ryogen Zaikokuji, Atsumu Matsumoto, Hiroki Kitagaki, Yuto Tamaoki, Takahiro Usui, Tomoaki Doi, Takahiro Yoshida, Shozo Yoshida, Hiroaki Ushikoshi, Izumi Toyoda, Shinji Ogura
BACKGROUND: Sugar-protein glycocalyx coats healthy endothelium, but its ultrastructure is not well described. Our aim was to determine the three-dimensional ultrastructure of capillary endothelial glycocalyx in the heart, kidney, and liver, where capillaries are, respectively, continuous, fenestrated, and sinusoidal. METHODS: Tissue samples were processed with lanthanum-containing alkaline fixative, which preserves the structure of glycocalyx. RESULTS: Scanning and transmission electron microscopy revealed that the endothelial glycocalyx layer in continuous and fenestrated capillaries was substantially thicker than in sinusoids...
October 23, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058589/translational-evidence-for-two-distinct-patterns-of-neuroaxonal-injury-in-sepsis-a-longitudinal-prospective-translational-study
#16
Johannes Ehler, Lucinda K Barrett, Valerie Taylor, Michael Groves, Francesco Scaravilli, Matthias Wittstock, Stephan Kolbaske, Annette Grossmann, Jörg Henschel, Martin Gloger, Tarek Sharshar, Fabrice Chretien, Francoise Gray, Gabriele Nöldge-Schomburg, Mervyn Singer, Martin Sauer, Axel Petzold
BACKGROUND: Brain homeostasis deteriorates in sepsis, giving rise to a mostly reversible sepsis-associated encephalopathy (SAE). Some survivors experience chronic cognitive dysfunction thought to be caused by permanent brain injury. In this study, we investigated neuroaxonal pathology in sepsis. METHODS: We conducted a longitudinal, prospective translational study involving (1) experimental sepsis in an animal model; (2) postmortem studies of brain from patients with sepsis; and (3) a prospective, longitudinal human sepsis cohort study at university laboratory and intensive care units (ICUs)...
October 23, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058600/finding-the-precision-to-improve-outcome-in-patients-after-cardiac-arrest
#17
LETTER
Gentle Sunder Shrestha
No abstract text is available yet for this article.
October 22, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058580/sleeping-with-the-enemy-clostridium-difficile-infection-in-the-intensive-care-unit
#18
REVIEW
Florian Prechter, Katrin Katzer, Michael Bauer, Andreas Stallmach
Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4-4% and has severe impact on morbidity and mortality. An estimated 10-20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection...
October 22, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058607/aerosol-delivery-during-invasive-mechanical-ventilation-a-systematic-review
#19
Jonathan Dugernier, Stephan Ehrmann, Thierry Sottiaux, Jean Roeseler, Xavier Wittebole, Thierry Dugernier, François Jamar, Pierre-François Laterre, Gregory Reychler
BACKGROUND: This systematic review aimed to assess inhaled drug delivery in mechanically ventilated patients or in animal models. Whole lung and regional deposition and the impact of the ventilator circuit, the artificial airways and the administration technique for aerosol delivery were analyzed. METHODS: In vivo studies assessing lung deposition during invasive mechanical ventilation were selected based on a systematic search among four databases. Two investigators independently assessed the eligibility and the risk of bias...
October 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29058601/role-of-renal-function-in-risk-assessment-of-target-non-attainment-after-standard-dosing-of-meropenem-in-critically-ill-patients-a-prospective-observational-study
#20
Lisa Ehmann, Michael Zoller, Iris K Minichmayr, Christina Scharf, Barbara Maier, Maximilian V Schmitt, Niklas Hartung, Wilhelm Huisinga, Michael Vogeser, Lorenz Frey, Johannes Zander, Charlotte Kloft
BACKGROUND: Severe bacterial infections remain a major challenge in intensive care units because of their high prevalence and mortality. Adequate antibiotic exposure has been associated with clinical success in critically ill patients. The objective of this study was to investigate the target attainment of standard meropenem dosing in a heterogeneous critically ill population, to quantify the impact of the full renal function spectrum on meropenem exposure and target attainment, and ultimately to translate the findings into a tool for practical application...
October 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
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