Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 JA, Summers Rl. eT al (Univ of Mississippi Med Ctr, Jackson; Carolinas Med Cir, Charlotte. NC)Acad Emerg Med 19:983 985, 2012Objectives.—Previous studies have confirmed rhe prognostic significance of lactate concentrations categorized into groups (low, intermediate, high) among emergency department Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 (ED) patients with suspected infection. Although the relationship between lactate concentrations categorized into groups and mortality appears to beEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
linear, rhe relationship between lactate as a continuous measurement and mortality is uncertain. This study sought to evaluate the association between6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 analysis of adult ED patients with suspected infection from a large urban ED during 2007—2010. Inclusion criteria were suspected infection evidenced by administration of antibiotics in the ED and measurement of whole blood lactate in the ED. The primary outcome was in-hospital mortality. Logistic a Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2nd polynomial regression were used to model the relationship between lactate concentration and mortality.Results.—A total of 2,596 patients met inclusEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
ion criteria and were analyzed. The initial median lactate concentration was 2.1 mmol/L (interquartile range 11QR] = 1.3 to 3.3 mmol/L) and the overal6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2m of incremental elevations, from 6% for lacrare < 1.0 mmol/I. up ro 39% for lacrare 19 20 nimol/E. Polynomial regression analysis showed a strong curvilinear correlation between lactate and mortality (R = 0.72, p < 0.0001).Conclusions. In ED patients with suspected infection, we found a curvilinear Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 relationship between incremental elevations in lacrare concentration and mortality’. These data support rhe use of lactate as a continuous variable rEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
ather than a categorical variable for prognostic purposes.► Previous studies have shown that increased serum lactate correlates with increased mortali6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2variable (it is after all) correlated with mortality in patients with135136 / Critical Care Medicinesuspected infection. Patients admitted to the hospital from the emergency department were included if they had suspected infection (antibiotics given in the emergency department) and a lactate measure Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2ment obtained. More than 2500 patients were enrolled and they seemed to represent a typical sepsis cohort based on length of stay, comorbidities, andEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
mortality. The authors found definite correlations between incremental increases ol lactate and incremental increases in mortality. They developed a r6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 well done by a group of researchers with a good track record. Pay attention to lactate in patients with suspected infection: rhe higher it is, the more likely rhe patient in front of you is going to die.M. D. Zwank, MDCan changes in arterial pressure be used to detect changes in cardiac index durin Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2g fluid challenge in patients with septic shock?Pierrakos c. Velissaris D, Scolletta s, et al (Frasme Univ Hosp, Brussels, Belgium)Intensive Care MedEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
38:422-428, 2012Purpose.—Response to fluid challenge is often defined as an increase in cardiac index (CI) of more than 10—15%. However, in clinical p6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2enge in patients with septic shock.Methods.—This was an observational study in which we reviewed prospectively collected data from 51 septic shock patients in whom complete hemodynamic measurements had been obtained before and after a fluid challenge with 1,000 ml crystalloid (Hartman’s solution) or Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 500 ml colloid (hydroxyethyl starch 6%). Cl was measured using thermodilution. Patients were divided into two groups (responders and nonresponders) aEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
ccording to their change in Cl (responders: %Cl>10%) after the fluid challenge. Statistical analysis was performed using a two-way analysis of varianc6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2ysis were also used.Results. Mean patient age was 67 ± 17 years and mean Sequential Organ Failure Assessment (SOFA) upon admittance to the intensive care unit was 10 ± 3. In rhe 25 responders, MAP increased from 69 ± 9 to 77 ± 9 mmHg, pulse pressure (PP) increased from 59 ± 15 to 67 ± 16, and CI inc Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2reased from 2.8 ± 0.8 to 3.4 ± 0.9 I7min/m2 (all p< 0.001). T here were no significant correlations between the changes in MAP, pp, and Cl.ConclusionsEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
.—Changes in MAP do not reliably track changes in CI after fluid challenge in patients with septic shock and, consequently,Chapter 6—Sepsis/Seplic Sho6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2eness in shock are highly sought after but often remain illusive. In a prospective observational study. Pierrakoset al assessed whether changes in arterial pressure could predict fluid responsiveness of 51 septic shock patients by determining the percentage ol change in cardiac index (Cl) via the th Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2ermodilution method. Hall of the patients were determined to be fluid responders as defined by a greater than 10% increase in Cl after fluid challengeEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
with 1 I crystalloid or 500 ml colloid bolus. While pulse pressure and mean arterial pressure (MAP) significantly increased in responders when chai l6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2x should caution the intensivist that an increase in MAP after volume expansion does not necessarily improve hemodynamic status. In other words, augmentation of MAP with a fluid challenge does not accurately identify fluid responsiveness in septic shock patients.E. Damuth, MDMultiplex polymerase cha Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2in reaction pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgeryTran NK. Wisner DH, Albertson ĨE. et alEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
(Univ of California. Davis)Surgery 151:456-463. 2012Background.— The goal of this study is to determine the clinical value of multiplex polymerase cha6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2thogen detection quickly reveals occult bloodstream infections in these high-risk patients and may accelerate the initiation of targeted antimicrobial therapy.Methods. We conducted a prospective observational study comparing results for 30 trauma and emergency surgery patients to 20 burn patients. W Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2hole-blood samples collected with routine blood cultures (BCs) were tested using a new multiplex, PCR-based, pathogen detection system. PCR results weEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
re compared to culture data.Results. PCR detected rapidly more pathogens than culture methods. Acute Physiology and Chronic Health Evaluation II (APAC6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2ma and emergency surgery patients (P<.033). Negative PCR results (odds ratio, 0.194; 95% confidence interval, 0.045-0.840; p =.028) acted as an independent predictor of survival for the combined surgical patient population.Conclusion.—PCR detected rhe presence of pathogens more frequently than blood Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2 culture. These PCR results were reported faster than blood culture results. Severity scores were significantly greater in PCR-positive138 / CriticalEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
Care Medicinetrauma and emergency surgery patients, rhe lack of pathogen DNA as determined by PCR served as a significant predictor of survival in the6 Sepsis/Septic ShockPrognostic Value of Incremental Lactate Elevations in Emergency Department Patients With Suspected InfectionPuskaric.h MA, Kline Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2rant further investigation through interventional trials.► Trauma, emergency, and burn surgery patients are at a particularly high risk 0Í septicemia secondary to their disease stales. As a result, immediate empiric antibiotic treatment is necessary to improve mortality.' However, with increasing re Ebook Year book - Year book of critical care medicine 2013 (1st edition): Part 2sistant pathogens, aggressive de-escalation is important as well.In this prospective, observational study, patients displaying signs and symptoms of sEbook Year book - Year book of critical care medicine 2013 (1st edition): Part 2
epsis had blood cultures and blood samples run through polymerase chain reaction (PCR). Arbitrated case reviews were performed to determine if approprGọi ngay
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