1,721,022 research outputs found
Incidence, associated clinical factors and outcome of hypertensive crises in critically Ill patients: A prospective survey
No full textBackground: Hypertensive crises (HCs) are common among critically ill patients. However, little is known of their epidemiology, particularly actual rate and outcome of affected patients. Primary end-point of the study was to assess incidence of and clinical factors associated with HCs in a cohort of patients admitted to a general ICU. Secondary end-point was to assess the impact of HC on patients' outcome. Methods: All patients consecutively admitted to a general ICU over a 13 months period were included in the study. Incidence of HCs was assessed and associated clinical factors were determined using univariate and multivariate analysis. Length-of-stay and ICU- and in-hospital mortality were evaluated. Results: Incidence of HCs was 15.4%. Factors independently associated with HCs were: ICU-admission for acute medical conditions, cigarette smoking, cancer, coronary artery disease, chronic atrial fibrillation (p<0.05). ICU length-of-stay and ICU-/ in-hospital mortality rate were higher among patients with HCs (p<0.05). Conclusion: HCs are common in critically Ill patients, even if previously normotensive, and are associated with a worse outcome. Associated clinical factors include acute medical conditions leading to ICU admission, cigarette smoking, cancer, coronary artery disease and chronic atrial fibrillation. © 2011 Chelazzi C, et al
Serum insulin-like growth factor binding protein 1 and C-peptide to assess insulin resistance in septic patients
No full textTotal pain, opioids, and immune checkpoint inhibitors in the survival of patients with cancer
Full text link: Experimental and observational studies have shown that opioid analgesics may increase tumor growth, potentially reduce immunotherapy efficacy, and shorten survival. As a result of the lack of clinical data, the current rationale for continuing opioid analgesic treatment is based on animal models, which suggests that physical pain itself may potentially influence cancer growth and exert immunosuppressive effects. Total pain encompasses the various factors that patients may experience during their cancer journey: physical symptoms, social isolation/loneliness, psychological, spiritual/existential, and financial distress. These need to be screened and discussed with patients to help them cope with the treatment and disease. As each issue may affect survival, it is essential to identify them to understand how they might affect the patient's immune system, influence immunotherapy outcomes, and ultimately, survival. The question arises whether a single factor, such as the combination of opioids and immune checkpoint inhibitors, negatively affects treatment outcomes. While there is a risk of fostering opioid phobia, the complex interplay between total pain, quality of life, and the immune system must be considered. Thus, in studies that appropriately investigate the interactions between opioid analgesics and the immune system, it is essential to consider all the distress factors that patients may experience at each stage of their illness
The significance of microalbuminuria in critical illness
No full textMicroalbuminuria seems to reflect the function of the glomerular and systemic endothelium and it could be used to monitor the endothelial function in critically ill patients with signs of a systemic inflammatory response. The aim of the present article is to review the significance of microalbuminuria separately in surgical, trauma, cardiac and medical intensive care unit (ICU) patients. In surgical ICU patients microalbuminuria persisting for more than 6-24 h seems to correlate with postoperative septic complications and with ICU mortality, even if with a low positive predictive value. In trauma ICU patients, microalbuminuria levels 6-24 h after trauma correlate with severity of illness, ICU mortality and ICU stay, whereas microalbuminuria levels in the first 6-24 h after trauma is more correlated just to the entity of trauma. In cardiac patients with acute miocardial infarction, microalbuminuria is correlated both with hospital mortality and at least 3 yr outcome. In medical ICU patients microalbuminuria 4-6 h after ICU admission is a strong predictor of ICU mortality and severity of illness. This review suggests that, in ICU patients, microalbuminuria could integrate clinical severity scores to monitor the systemic inflammatory response and to predict severity of illness and mortality. © 2007
Antibiotics and artificial nutrition in the cardiac intensive care unit
No full textPatients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome. A deep understanding of antibacterial agents pharmacology in the critically ill is essential in order to treat severe infections; moreover, it is necessary to know routes of administration and composition of artificial nutrition solutions. The aim of this review is to define main and specific aspects of antibiotic therapy and nutritional support in cardiac critical care patients in light of recent literature data. © 2010 AIM Publishing Srl
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