1,723,078 research outputs found
Intensive care medicine in 2050: the future of ICU treatments
No full textSCOPUS: ed.jinfo:eu-repo/semantics/publishe
A prospective evaluation of the Infection Probability Score (IPS) in the intensive care unit
No full textObjectives: Identification of infection remains a major challenge, particularly in acutely ill patients. The Infection Probability Score (IPS) was developed to help rule out infection in acutely ill patients. In the present study, we determined the IPS in acutely ill, intensive care unit (ICU) patients to assess its use in the diagnosis and treatment of infection. Methods: In this prospective, observational study, we enrolled 107 consecutive patients who were admitted to the ICU without antibiotic therapy. Patients were allocated to four groups according to the probability of infection determined from clinical and microbiological data and their IPS values were then evaluated daily throughout the ICU stay. Results: The IPS was higher in patients with the highest clinical probability of infection and decreased significantly in these patients after 5 days of effective antimicrobial therapy. The IPS remained below the cut-off value in non-infected patients. Patients in whom inadequate antimicrobial therapy was administered had a greater mortality than the other patients. Conclusions: The IPS had a good predictive value for diagnosis of infection. In addition, dynamic evaluation of this score may help to assess the response to therapy. © 2008 The British Infection Society.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Recent Advances in the Natural History of Dilated Cardiomyopathy: A Review of the Heart Muscle Disease Registry of Trieste
No full textMicrocirculatory alterations in patients with severe sepsis: Impact of time of assessment and relationship with outcome
No full textOBJECTIVES: Sepsis induces microvascular alterations that may play an important role in the development of organ dysfunction. However, the relationship of these alterations to systemic variables and outcome is still not well defined. We investigated which factors may influence microcirculatory alterations in patients with severe sepsis and whether these are independently associated with mortality. DESIGN: Analysis of prospectively collected data from previously published studies by our group. SETTING: A 36-bed, medicosurgical university hospital Department of Intensive Care. PATIENTS: A total of 252 patients with severe sepsis in whom the sublingual microcirculation was visualized using orthogonal polarization spectral or sidestream darkfield imaging techniques. MEASUREMENTS AND MAIN RESULTS: Microcirculatory measurements were obtained either early, within 24h of the onset of severe sepsis (n = 204), or later, after 48h (n = 48). When multiple measurements were obtained, only the first was considered. Although global hemodynamic variables were relatively preserved (mean arterial pressure 70 [65-77] mm Hg, cardiac index 3.3 [2.7-4.0] L/min.m, and SvO2 68.3 [62.8-74.7]%), microvascular variables were markedly altered (proportion of perfused small vessels 65 [50-74]%, microvascular flow index 2.15 [1.80-2.60], and heterogeneity of proportion of perfused small vessels 35 [20-50]%). Among microcirculatory variables, proportion of perfused small vessels was the strongest predictor of outcome (receiver operating characteristic curve area 0.818 [0.766-0.871], p < 0.001). Survival rates decreased markedly with severity of alterations in the proportion of perfused small vessels (70% and 75% in the two upper proportion of perfused small vessel quartiles compared with 3% and 44% in the two lower quartiles, p < 0.0001). Multivariable analysis identified proportion of perfused small vessels and sequential organ failure assessment score as independent predictors of outcome. Microcirculatory alterations were less severe in the later than in the earlier (proportion of perfused small vessels, 74 [57-82]% vs. 63 [48-71]%, p = 0.004) phase of sepsis. In multivariable analysis focused on the early period of sepsis, proportion of perfused small vessels and lactate were independent predictors of outcome. CONCLUSIONS: Microcirculatory alterations are stronger predictors of outcome than global hemodynamic variables. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Regulation of mitochondrial function by hypoxia and inflammation in sepsis: A putative role for hypoxia inducible factor
No full textSepsis-related organ failure is the leading cause of mortality in European intensive care units (ICU). Although the inflammatory cascade of mediators in response to infection is well known, the relationships between regional inflammation, microvascular heterogeneity, hypoxia and hypoxia-inducible gene expression, and finally, organ dysfunction, are unknown. Growing evidence suggests that not only low oxygen supply to the tissues secondary to macrovascular and microvascular alterations, but also altered cellular oxygen utilization is involved in the development of multiorgan dysfunction [1]–[3]. Microbial products and innate and adaptive dysregulated immune response to infection directly affect parenchymal cells of organs and may contribute to multiorgan dysfunction
Impact of reimbursement schemes on quality of care in the ICU: A European perspective
No full textEditorialSCOPUS: ed.jinfo:eu-repo/semantics/publishe
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