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991.
In an observational multicenter study, Elseviers and colleagues report that renal replacement therapy (RRT) in acutely ill
patients treated for acute kidney injury is an independent risk factor for death. This result may question the benefit of
the current practice of early RRT initiation. 相似文献
992.
Azoulay E Demoule A Jaber S Kouatchet A Meert AP Papazian L Brochard L 《Intensive care medicine》2011,37(8):1250-1257
Over the last two decades, the increasing use of noninvasive ventilation (NIV) has diminished the need for endotracheal ventilation,
thus decreasing the rate of ventilation-induced complications. Thus, NIV has decreased both intubation rates and mortality
rates in specific subsets of patients with acute respiratory failure (e.g., patients with hypercapnia, cardiogenic pulmonary
edema, immune deficiencies, or post-transplantation acute respiratory failure). NIV is also increasingly used as a palliative
strategy when endotracheal ventilation is deemed inappropriate. In this context, palliative NIV can either be administered
to offer a chance for survival, or to alleviate the symptoms of respiratory distress in dying patients. The literature provides
information from 10 studies published between 1992 and 2006, in which 458 patients received palliative NIV. The technique
was feasible, usually well tolerated, and half of the patients survived. The objectives of this review article are to define
palliative NIV, to delineate the place for palliative NIV among overall indications of NIV, and to define the contribution
of NIV to the palliative strategies available for patients with acute respiratory failure. Potential benefits and harm from
NIV in patients who are not eligible for endotracheal ventilation are discussed. The appropriateness of palliative NIV should
be reported in a study that relies on both quantitative criteria (rate of palliative NIV use and mortality) and qualitative
criteria (patient comfort, end-of-life process, family burden, and health-care provider satisfaction). 相似文献
993.
Guitton C Gérard N Sébille V Bretonnière C Zambon O Villers D Charreau B 《Intensive care medicine》2011,37(6):950-956
Purpose
The endothelial protein C receptor (EPCR) negatively regulates the coagulopathy and inflammatory response in sepsis. Mechanisms controlling the expression of cell-bound and circulating soluble EPCR (sEPCR) are still unclear. Moreover, the clinical impact of EPCR shedding and its potential value to predict sepsis progression and outcome remain to be established. 相似文献994.
Ince C 《Critical care (London, England)》2005,9(Z4):S13-S19
Regional tissue distress caused by microcirculatory dysfunction and mitochondrial depression underlies the condition in sepsis and shock where, despite correction of systemic oxygen delivery variables, regional hypoxia and oxygen extraction deficit persist. We have termed this condition microcirculatory and mitochondrial distress syndrome (MMDS). Orthogonal polarization spectral imaging allowed the first clinical observation of the microcirculation in human internal organs, and has identified the pivotal role of microcirculatory abnormalities in defining the severity of sepsis, a condition not revealed by systemic hemodynamic or oxygen-derived variables. Recently, sublingual sidestream dark-field (SDF) imaging has been introduced, allowing observation of the microcirculation in even greater detail. Microcirculatory recruitment is needed to ensure adequate microcirculatory perfusion and the oxygenation of tissue cells that follows. In sepsis, where inflammation-induced autoregulatory dysfunction persists and oxygen need is not matched by supply, the microcirculation can be recruited by reducing pathological shunting, promoting microcirculatory perfusion, supporting pump function, and controlling hemorheology and coagulation. Resuscitation following MMDS must include focused recruitment of hypoxic-shunted microcirculatory units and/or resuscitation of the mitochondria. A combination of agents is required for successful rescue of the microcirculation. Single compounds such as activated protein C, which acts on multiple pathways, can be expected to be beneficial in rescuing the microcirculation in sepsis. 相似文献
995.
Akihiro Kurita Hidehiko Itoh Fumi Sato Yasuhiro Ichibori Akira Yoshida 《Journal of Medical Ultrasonics》2008,35(3):113-118
Purpose Although alterations in longitudinal systolic function have been considered the earliest sign of cardiac damage, the importance
of longitudinal fractional shortening (LFS), which reflects left ventricular longitudinal contraction, has not been studied
in detail. We introduce a new method of measuring LFS by echocardiography and evaluate its efficiency.
Methods Our study population consisted of 120 patients with diabetes mellitus (DM), 29 healthy volunteers, and 12 patients with coronary
artery disease (CAD). LFS was assessed echocardiographically. Patients with DM underwent conventional echocardiography, assessment
of left ventricular diastolic function, and pulsed-wave tissue Doppler study.
Results LFS was 0.07 ± 0.02 in patients with CAD, 0.16 ± 0.05 in patients with DM, and 0.26 ± 0.04 in the normal controls. The three
groups differed significantly with respect to the mean LFS values, which were significantly lower in patients with DM than
in the normal controls. The ratio of peak diastolic velocities during early filling and atrial contraction (Em/Am) measured
on pulsed-wave tissue Doppler images was significantly correlated with LFS (r = 0.37, P < 0.0001).
Conclusion LFS is correlated with diastolic cardiac function and is a useful and sensitive index for evaluating long-axis systolic function. 相似文献
996.
Sachiko Miura Eijitsu Haku Toshiko Hirai Nagaaki Marugami Takahiro Itoh Takehiro Tanaka Kimihiko Kichikawa Hajime Ohishi 《Journal of Medical Ultrasonics》2008,35(2):51-56
Purpose During conservative therapy of infantile hypertrophic pyloric stenosis (IHPS) with atropine sulfate, there are many patients
who do not achieve normal values of pyloric wall thickness and canal length even though they are clinically cured (vomiting
has ceased); an objective criterion for cure has not yet been established. The aim of this study was to examine whether the
appearance of pyloric wall stratification can be used as a criterion for cure.
Methods Twenty infants with IHPS who were treated conservatively were enrolled. Two of them ultimately required surgery. Ultrasound
examinations were done serially and the pyloric wall thickness and canal length were measured. The echogenicity of the pyloric
wall and the presence of wall stratification were noted.
Results On admission, all infants satisfied the ultrasound criteria for IHPS and had a heterogeneous pyloric wall without stratification.
With conservative therapy, symptoms disappeared, the pyloric wall thickness and the canal length gradually decreased, the
echogenicity gradually became homogeneous and hypoechoic, and wall stratification appeared (in most cases before the pyloric
wall thickness and the canal length had normalized). The absence of wall stratification suggests that cellular interstitial
changes, such as edema or inflammation, are present in the pyloric wall in the acute stage.
Conclusion Pyloric wall stratification was absent during the acute stage, but it appeared after initiation of treatment but before the
pyloric wall thickness and the canal length had normalized. The presence of pyloric wall stratification can be used as a criterion
for cure; the absence of wall stratification can be added to ultrasound diagnostic criteria for IHPS. 相似文献
997.
Jean Klastersky Marianne Paesmans Institut Jules Bordet Centre des Tumeurs de l’Université Libre de Bruxelles 《Supportive care in cancer》2007,15(5):477-482
Background Among patients who develop fever and neutropenia after having received cancer chemotherapy, we have to distinguish at least
three categories of risk levels for complications and death: patients at low risk and eligible for oral treatment and possibly
outpatient management, patients at low risk who require intravenous therapy, and patients at higher risk.
Results and discussion The Multinational Association for Supportive Care in Cancer scoring system identifies patients at low risk (<5%) of severe
complications with very low mortality (<1%) during an episode of febrile neutropenia; this group represents roughly 70% of
an unselected population of patients with febrile neutropenia. A significant percentage (≈50%) of these patients are eligible
for treatment with orally administered antibiotics and can be discharged early and safely from the hospital after a short
(24–48 h) observation period. 相似文献
998.
Venita DePuy Kevin J. Anstrom Liana D. Castel Kevin A. Schulman Kevin P. Weinfurt Fred Saad 《Supportive care in cancer》2007,15(7):869-876
Goals of work Patients with prostate cancer metastasized to bone frequently experience skeletal morbidities as a result of their disease.
We sought to quantify the longitudinal effects on patient-reported outcomes of skeletal-related events (SREs) and to ascertain
the declines in health-related quality of life (HRQOL) and pain experienced by patients who experienced SREs.
Materials and methods Data are from a clinical trial for the treatment of SREs associated with advanced prostate cancer metastatic to bone. Outcome
measures included the Functional Assessment of Cancer Therapy-General (FACT-G) and the Brief Pain Inventory. Among patients
who survived 6 months after randomization, patients with no SREs in the initial 6 months after randomization were matched
via propensity scores with those experiencing one or more SREs. Similarly, patients with one SRE were matched with a subset
of patients with two or more SREs.
Main results Patients with SREs in the initial period had significantly worse survival and HRQOL than those with no SREs. Significant differences
were found between the pain differences, FACT-G total scores, and FACT-G physical, emotional, and functional subscales. Comparisons
of patients with single vs multiple SREs showed similar patterns.
Conclusions The presence of SREs is significantly associated with worse survival and poorer HRQOL in this patient population. Increasing
SRE intensity shows a pattern of increasingly decreased survival and poorer HRQOL.
Ms DePuy is now with INC Research, Raleigh, NC, USA. 相似文献
999.
Oleksa G. Rewa Pierre-Marc Villeneuve Philippe Lachance Dean T. Eurich Henry T. Stelfox R. T. Noel Gibney Lisa Hartling Robin Featherstone Sean M. Bagshaw 《Intensive care medicine》2017,43(6):750-763
Objectives
Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients.Design
A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle–Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively.Measurements and main results
Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors.Conclusions
We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise inventory of QIs to measure, improve, and benchmark CRRT care for critically ill patients.Systematic review registration
PROSPERO CRD42015015530.1000.