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Stephan von Haehling Joerg C. Schefold Lea Majc Hodoscek Wolfram Doehner Marwan Mannaa Stefan D. Anker Mitja Lainscak 《Clinical research in cardiology》2010,99(2):107-113
Background
Acute heart failure is associated with a poor prognosis. It is important to identify patients at increased risk of adverse events. The presence of anaemia could help in this regard. 相似文献42.
Francis RC Schefold JC Bercker S Temmesfeld-Wollbrück B Weichert W Spies CD Weber-Carstens S 《Intensive care medicine》2009,35(2):360-363
Objective To report on the recurrent release of charcoal from an intrapulmonary cavern in a case of acute respiratory failure after
charcoal aspiration.
Design Case report.
Setting Anaesthesiological ICU, university hospital.
Patient An 18-year-old ethanol intoxicated comatose patient regurgitated and aspirated activated charcoal during orotracheal intubation.
Treatment After 2 days of mechanical ventilation, the patient was transferred to a tertiary care university hospital. On admission,
acute respiratory distress syndrome with bilateral pulmonary infiltrations was diagnosed. The patient’s recovery was hampered
by recurrent release of charcoal from an intrapulmonary cavern. Sophisticated ventilatory support, prone positioning, secretolytics,
repetitive bronchoscopy, and antibiotic therapy may have facilitated bronchoalveolar clearance and weaning after 18 days.
Conclusion Aspiration may be a dramatic complication if charcoal is administered in comatose patients without airway protection. In this
case report, advanced intensive care measures were necessary to tackle the special feature of charcoal release from an intrapulmonary
cavern. 相似文献
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Stress ulcer prophylaxis in the intensive care unit trial: detailed statistical analysis plan 下载免费PDF全文
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Storm C Steffen I Schefold JC Krueger A Oppert M Jörres A Hasper D 《Critical care (London, England)》2008,12(3):R78-8
Introduction
Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implications. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients. In this analysis, we investigate whether therapeutic hypothermia influences the length of intensive care unit (ICU) stay and ventilator time in patients surviving out-of-hospital cardiac arrest.Methods
A prospective observational study with historical controls was conducted at our medical ICU. Fifty-two consecutive patients (median age 62.6 years, 43 males, 34 ventricular fibrillation) submitted to therapeutic hypothermia after out-of-hospital cardiac arrest were included. They were compared with a historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior to hypothermia treatment. All patients received the same standard of care. Neurological outcome was assessed using the Pittsburgh cerebral performance category (CPC) score. Univariate analyses and multiple regression models were used.Results
In survivors, therapeutic hypothermia and baseline disease severity (Acute Physiology and Chronic Health Evaluation II [APACHE II] score) were both found to significantly influence ICU stay and ventilator time (all P < 0.01). ICU stay was shorter in survivors receiving therapeutic hypothermia (median 14 days [interquartile range (IQR) 8 to 26] versus 21 days [IQR 15 to 30] in the control group; P = 0.017). ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 and P = 0.034, respectively). Kaplan-Meier analysis showed improved probability for 1-year survival in the hypothermia group compared with the controls (log-rank test P = 0.013).Conclusion
Therapeutic hypothermia was found to significantly shorten ICU stay and time of mechanical ventilation in survivors after out-of-hospital cardiac arrest. Moreover, profound improvements in both neurological outcome and 1-year survival were observed. 相似文献46.
Schefold JC Boldt LH Pschowski R Reinke P Hasper D 《Critical care medicine》2008,36(11):3130-1; author reply 3131
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Sadeghi M Lahdou I Daniel V Schnitzler P Fusch G Schefold JC Zeier M Iancu M Opelz G Terness P 《Human immunology》2012,73(2):186-192
Infection-induced inflammation triggers catabolism of proteins and amino acids. Phenylalanine and tryptophan are 2 amino acids related to infections that regulate immune responses. Polyomavirus BK (BKV) and cytomegalovirus (CMV) are important pathogens after kidney transplantation. We investigated the clinical relevance of phenylalanine, tryptophan, and tryptophan metabolites (kynurenine and quinolinic acid) plasma levels in kidney transplant recipients with active CMV (BKV(-)CMV(+), n = 12) or BK virus infection (BKV(+)CMV(-), n = 37). Recipients without active viral infections (CMV(-)BKV(-), n = 28) and CMV(-)BKV(-) healthy individuals (HCs, n = 50) served as controls. In contrast to BKV infection, activated CMV infection is tightly linked to increased phenylalanine and tryptophan metabolite plasma levels (p ≤ 0.002). The association of phenylalanine (cutoff 50 μmol/L) with CMV infection demonstrates high sensitivity (100%) and specificity (94%). By contrast, kynurenine (p = 0.029) and quinolinic acid (p = 0.003) values reflect the severity of CMV infection. In this early proof-of-concept trial, evidence indicates that activated CMV infection is strongly associated with increased phenylalanine as well as kynurenine and quinolinic acid plasma levels. Moreover, tryptophan metabolite levels correlate with disease severity. Measurement of these amino acids is an inexpensive and fast method expected to complete conventional diagnostic assays. 相似文献
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