The open critical care medicine journal最新文献

{"title":"Determination of Brain Death: An Overview with a Special Emphasis on New Ultrasound Techniques for Confirmatory Testing","authors":"A. Günther, H. Axer, J. L. Llompart Pou, O. Witte, Christoph Terborg","doi":"10.2174/1874828701104010035","DOIUrl":"https://doi.org/10.2174/1874828701104010035","url":null,"abstract":"Progress in resuscitation medicine and the widespread success of cardiopulmonary support in intensive care medicine called for new standards for determining a patients death. Following a worldwide discussion on the medical, ethical, and legal aspects of death, the term brain death is now a generally accepted criterion for death. Brain death, defined as complete and irreversible cessation of brain function was established to describe an individuals death even during artificial ventilation and a temporary maintenance of cardiac function in the ICU setting. The determination of brain death requires adequate prerequisites, as well as clinical findings verifying a complete loss of function of the entire brain, and a confirmation of its irreversibility. Most countries have national guidelines aimed at providing a high-quality medical standard and to exclude any conflicts of interest. On confirmation of brain death, life-sustaining therapies are discontinued in accordance with the declared or assumed will of the dead individual. Only in cases of an intended organ donation, organ protective measures need to be continued until surgery. In this overview, we aim to outline the components of determining clinical brain death with a special emphasis on new ultrasound techniques for confirmatory testing.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"9 1","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74668403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological Sequelae of Sepsis: II) Neuromuscular Weakness","authors":"H. Axer","doi":"10.2174/1874828701104010008","DOIUrl":"https://doi.org/10.2174/1874828701104010008","url":null,"abstract":"Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) have been established as separate entities of muscular weakness in critically ill patients, although both may be associated to each other in some respects. Both are associated to systemic inflammatory response syndrome, sepsis, and severe sepsis. Major signs of nerve and muscle disturbances in critically ill patients are muscle weakness and problems of weaning from the ventilator. Electroneurographic measurements help to detect CIP early in the course of the disease, while muscle biopsy seems to date the diagnostic tool of choice to detect CIM. Sepsis therapy is the major target to prevent the development of CIP and CIM. However, no specific therapy of CIP and CIM has been established in the past. Therefore, management of patients with CIP and CIM is mainly supportive. Neuromuscular weakness cause elongated times of ventilation, elongated hospital stay, elongated times of rehabilitation, and increased mortality. This review provides an overview of clinical and diagnostic features of CIP and CIM, and summarizes current pathophysiological and therapeutic concepts.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"49 1","pages":"8-14"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77947372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Ultrasonography~!2009-04-15~!2009-06-02~!2010-07-15~!","authors":"Babak Hakimisefat, P. Mayo","doi":"10.2174/1874828701003020021","DOIUrl":"https://doi.org/10.2174/1874828701003020021","url":null,"abstract":"","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"43 1","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2010-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85682961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleural Ultrasonography~!2009-04-15~!2009-06-02~!2010-07-15~!","authors":"Subani Chandra, M. Narasimhan","doi":"10.2174/1874828701003020026","DOIUrl":"https://doi.org/10.2174/1874828701003020026","url":null,"abstract":"","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"2011 1","pages":"26-32"},"PeriodicalIF":0.0,"publicationDate":"2010-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82580123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Deep Venous Thrombosis by Critical Care Physicians Using Compression Ultrasonography~!2009-04-15~!2009-06-02~!2010-07-15~!","authors":"Christopher Dibello, Seth J. Koenig","doi":"10.2174/1874828701003020043","DOIUrl":"https://doi.org/10.2174/1874828701003020043","url":null,"abstract":"Lower extremity deep venous thrombosis is a common, serious, often under-recognized diagnosis in the critically ill patient. Its high association with pulmonary embolus necessitates both prompt diagnosis and constant surveillance. Point of care ultrasonography by the treating physician is gaining popularity because of its high accuracy and ease of performance coupled with an immediate response to a question often asked at the bedside. This review will highlight the advantages of compression ultrasonography compared to other diagnostic modalities and gives a practical approach in performing this simple exam by the critical care team.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"10 1","pages":"43-47"},"PeriodicalIF":0.0,"publicationDate":"2010-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87789084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Use of Ultrasound in the Intensive Care Unit","authors":"M. Rosen","doi":"10.2174/1874828701003020020","DOIUrl":"https://doi.org/10.2174/1874828701003020020","url":null,"abstract":"For decades, ultrasound technology has been an integral part of the practice of radiology, obstetrics and cardiology. Emergency medicine clinicians later became proficient and adopted it to evaluate patients with abdominal trauma, shock, obstetric emergencies, pericardial tamponade and other life-threatening disorders. For years, critical care physicians in Europe and parts of Asia have seen the value of ultrasonography in daily practice, and proved that with proper training and experience it can almost as accessible, and far more helpful than the stethoscope. For example, an intensivist can evaluate a patient in shock noninvasively and in a few minutes for the presence of pneumothorax, pericardial tamponade and ventricular dysfunction, while predicting with reasonable accuracy the likelihood that the shock state will respond to fluid resuscitation.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"35 1","pages":"20-20"},"PeriodicalIF":0.0,"publicationDate":"2010-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73984833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Ultrasound to Assess Fluid Responsiveness in the Intensive Care Unit~!2009-04-15~!2009-06-02~!2010-07-15~!","authors":"M. M. Kitakule, P. Mayo","doi":"10.2174/1874828701003020033","DOIUrl":"https://doi.org/10.2174/1874828701003020033","url":null,"abstract":"Determining the appropriate amount of fluid resuscitation to administer to a critically ill patient is a complex decision. Traditional tools for the assessment of preload sensitivity such as central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) are inaccurate in predicting whether a patient requires volume resuscitation (1). Diagnostic ultrasonography in the form of echocardiography offers an alternative means of determining whether a patient is preload sensitive. While the determination of the cause of hypotension in a trauma patient or one who is bleeding from a gastrointestinal source is straight forward, most patients in the medical ICU have multiple etiologies of shock. This requires careful assessment prior to institution of fluid therapy. Patients in the ICU who are hypotensive may be preload sensitive; however, in some circumstances, volume resuscitation may be detrimental (2, 3). For example, a patient in shock with acute cor-pulmonale and a dilated right ventricle should not receive volume resuscitation. Bedside echocardiography is a non-invasive tool that may be used to rapidly assess whether a patient with shock is fluid responsive.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"30 1","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2010-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88488811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TLR Cross-Talk Mechanism of Hemorrhagic Shock-Primed Pulmonary Neutrophil Infiltration.","authors":"Jie Fan","doi":"10.2174/1874828700902010001","DOIUrl":"https://doi.org/10.2174/1874828700902010001","url":null,"abstract":"<p><p>Hemorrhage resulted from severe trauma renders patients susceptible to the development of acute lung injury (ALI). The accumulation of polymorphonuclear neutrophils (PMN) in the lung is a critical event in the development of ALI. PMN migration is a result of a cascade of cellular events, in which PMN, endothelial cells (EC), and macrophages (Mϕ) act in concert. Recent studies explored interrelated novel findings indicating that Toll-like receptors (TLRs) cross-talk mechanisms occurring in PMN, EC, and Mϕ are important determinants for hemorrhage-primed PMN migration. In Mϕ and EC, LPS acts through TLR4 signaling to up-regulate TLR2. Oxidant signaling derived from hemorrhage-activated PMN NAD(P)H oxidase enhances the TLR2 upregulation through PMN-Mϕ or PMN-EC interaction, resulting in an amplified release of cytokines and chemokines from the Mϕ and expression of adhesion molecules in the EC in response to TLR2 ligands, thereby promoting PMN migration. This review provides an insight of the mechanisms.</p>","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"2 ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805003/pdf/nihms131007.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28645833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single-Center Review of Prescribing Trends and Outcomes of Corticosteroid Replacement Therapy in Critically Ill Children with Septic Shock.","authors":"Scott T Benken,&nbsp;Tamara K Hutson,&nbsp;Rhonda L Gardiner,&nbsp;Derek S Wheeler","doi":"10.2174/1874828701003010051","DOIUrl":"https://doi.org/10.2174/1874828701003010051","url":null,"abstract":"<p><p>Recently published consensus treatment guidelines for pediatric sepsis recommend initiating corticosteroid replacement therapy (CRT) for those critically ill children with adrenal insufficiency and refractory shock. The data to support this recommendation is limited, and multiple studies have demonstrated significant variation in both the diagnosis and treatment of adrenal insufficiency and refractory shock in children. In order to better define the variation in practice at our institution, we retrospectively reviewed the experience with CRT in critically ill children with refractory septic shock over a 1-year-period. In addition, as a secondary aim we compared outcomes in critically ill children treated with CRT for variable lengths of time. We found that the initiation of CRT at our center is relatively consistent. However, we noted significant variation in the duration of CRT and whether CRT was gradually tapered or stopped abruptly. The majority of the patients in our cohort received less than the currently recommended duration of 7 days of CRT. There were a higher number of treatment failures in those patients who received CRT for greater than 7 days, suggesting that CRT should be tapered gradually in these patients. There is significant variation in prescribing trends for CRT at our institution, which are likely to be compounded in any multi-center cohort study of CRT in critically ill children with septic shock. Practice variation in CRT should be standardized to address the impact of CRT in this population.</p>","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"3 ","pages":"51-56"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111024/pdf/nihms-300453.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29930328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissecting the Dualistic Effects of Transforming Growth Factor (TGF)-β on Fibroproliferation and Extracellular Matrix Production in PrimaryHuman Lung Fibroblasts – The Role of p38δ MAP Kinase","authors":"K. Hostettler, S. Goulet, M. Roth, J. Zhong, J. Burgess, J. Black, M. Tamm, P. Borger","doi":"10.2174/1874828700902010028","DOIUrl":"https://doi.org/10.2174/1874828700902010028","url":null,"abstract":"Rationale: Inflammation, increased fibroblast proliferation, and increased deposition of extracellular matrix (ECM) are hallmarks of early lung fibrosis and asthma. Transforming growth factor-� (TGF-� ) has been suggested as a key regulator of lung tissue homeostasis with several and often opposite effects on fibroblast proliferation and ECM production. In human and animal model systems, it has been shown that TGF-� induced several signaling cascades including Smads, p38 mitogen-activated protein (MAP) kinases, and extracellular signal-regulated kinases 1/2 (ERK). Information on how TGF- regulates and controls normal primary lung fibroproliferation and ECM production is not present. Objectives: We sought to dissect the effects of TGF-� on fibroproliferation and ECM production of primary adult human lung fibroblasts and elucidate the involved signaling pathways. Results: Depending on the presence of fetal bovine serum (FBS; 10%), TGF- exerted opposite effects on fibroproliferation. In the absence of FBS, low TGF- concentrations (0.01 and 0.001 ng/ml) significantly induced fibroproliferation. In the presence of FBS, TGF-� (1 ng/ml, 10 ng/ml) significantly reduced fibroproliferation. TGF- dose-dependently increased ECM deposition, which was independent of the presence of FBS. The anti-proliferative effect of TGF-� was associated with increased prostaglandin E2 (PGE2) production, that was induced via p38 and ERK 1/2 MAP kinases. Indomethacin (2.5 μM) and a small interfering RNA specific for p38 MAP kinase completely reversed the TGF-� -dependent inhibition of fibroblast proliferation. Conclusions: Both pro- and anti-proliferative cascades can be activated by TGF-� . In a mitogenic or inflammatory environment TGF-� induces PGE2 synthesis via activation of p38� MAP kinase, which then exerts a strong anti- proliferative effect. This dualistic nature of TGF- may exist in order to maintain lung tissue integrity.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"7 1","pages":"28-37"},"PeriodicalIF":0.0,"publicationDate":"2009-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80442141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}