Drotrecogin alfa (activated) in adults with septic shock.

Background: There have been conflicting reports on the efficacy of recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), for the treatment of patients with septic shock.

Methods: In this randomized, double-blind, placebo-controlled, multicenter trial, we assigned 1697 patients with infection, systemic inflammation, and shock who were receiving fluids and vasopressors above a threshold dose for 4 hours to receive either DrotAA (at a dose of 24 μg per kilogram of body weight per hour) or placebo for 96 hours. The primary outcome was death from any cause 28 days after randomization.

[Evaluation of the efficiency of care in the ICU].

Objective: To evaluate the efficiency of care in the ICU using a predictive model.

Design: A prospective, observational cohort study

Settings: Seventeen Spanish polyvalent ICUs.

Patients: A total of 1956 patients were initially considered (cohort A).

Effectiveness of an inspiratory pressure-limited approach to mechanical ventilation in septic patients.

Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see whether a protective strategy based approach with a plateau pressure <30 cmH(2)O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign international database. A retrospective analysis of an international multicentric database of 15,022 septic patients from 165 intensive care units was used.

Renal replacement therapy in the critical patient: treatment variation over time.

Objectives: To analyze the evolution of patients subjected to renal replacement therapy (RRT), and to determine risk factors associated with mortality and the recovery of renal function.

Design: A prospective, observational study of critically ill patients.

Setting: Clinical-surgical Intensive Care Unit (ICU) of Sabadell Hospital (Spain).

Distractor effects upon habituation of complex stimuli.

In two experiments, rats were given serial forward (the target followed by the distractor) or backward (the distractor followed by the target) exposure to two compound flavor stimuli that could be either similar (Salt-X/AX) or dissimilar (Salt-X/AY, Experiment 1; Salt/AX, Experiment 2). Following pre-exposure, the Salt element was presented in a compound with a novel flavor, N. The salience or effectiveness of the Salt element was then assessed by presenting the new flavor, N, under a state of salt appetite.

Prognostic implications of tissue oxygen saturation in human septic shock.

Purpose: To analyze the prognostic value of tissue oxygen saturation (StO(2)) in septic shock patients with restored mean arterial pressure (MAP).

Methods: This was a prospective observational study of patients admitted to the ICU in the early phase of septic shock, after restoration of MAP. Demographic data, severity score, hemodynamics, blood lactate, acid-base status, and StO(2) were measured at inclusion followed by a transient vascular occlusion test (VOT) to obtain the StO(2)-deoxygenation (DeOx) and StO(2)-reoxygenation (ReOx) rates.

Salience modulation in serial preexposure: implications for perceptual learning.

In three experiments rats were given serial preexposure to two flavor stimuli. In Experiment 1, some animals were given exposure to AX followed by the presentation of BX, a forward schedule; the others were given backward preexposure (BX→AX). Conditioning and test trials with the A element showed that salience or effectiveness of A was better protected in the forward than in the backward condition.

Differential time to positivity of blood cultures: a valid method for diagnosing catheter-related bloodstream infections in the intensive care unit.

Purpose: The validation in critical patients with short-term catheters of a method for diagnosing catheter-related bloodstream infection (CR-BSI), based on the differential time to positivity (DTP) of blood cultures.

Methods: Patients suspected of having CR-BSI were included. Two peripheral vein blood cultures and a catheter hub blood culture were simultaneously carried out.

The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.

Rationale: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.

Objective: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.

The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage Scores.

Objective: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decision rule based on 28-day mortality rates of admitted and refused patients.

Gender differences in landmark learning for virtual navigation: the role of distance to a goal.

We used a new virtual program in two experiments to prepare subjects to perform the Morris water task (www.nesplora.com).

Effectiveness of treatments for severe sepsis: data from the bundle implementation programs.

In severe sepsis, several studies, a recent meta--analysis and studies evaluating multifaceted strategies for quality improvement, have shown that bundled care can improve survival. Here, the effectiveness of treatments for severe sepsis included in the bundles was analyzed. Despite the observational design of the studies, possible biases are minimized using propensity scores and other adjustments.

Physiologic parameters as biomarkers: what can we learn from physiologic variables and variation?

Sepsis generates an overwhelming host response characterized by changes in physiologic parameters. Monitoring these parameters can help identify and stratify septic patients. Recognizing sepsis early and identifying septic patients at risk of worsening are keys to successful treatment.

Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis.

Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case.

Recombinant tissue factor pathway inhibitor in severe community-acquired pneumonia: a randomized trial.

Rationale: Severe community-acquired pneumonia (sCAP) is a leading cause of death worldwide. Adjunctive therapies for sCAP are needed to further improve outcome. A systemic inhibitor of coagulation, tifacogin (recombinant human tissue factor pathway inhibitor) seemed to provide mortality benefit in the sCAP subgroup of a previous sepsis trial.

Thenar oxygen saturation and invasive oxygen delivery measurements in critically ill patients in early septic shock.

This prospective study was aimed to test the hypothesis that tissue hemoglobin oxygen saturation (StO₂) measured noninvasively using near-infrared spectroscopy is a reliable indicator of global oxygen delivery (DO₂) measured invasively using a pulmonary artery catheter (PAC) in patients with septic shock. The study setting was a 26-bed medical-surgical intensive care unit at a university hospital. Subjects were adult patients in septic shock who required PAC hemodynamic monitoring for resuscitation.

Randomized trial evaluating serial protein C levels in severe sepsis patients treated with variable doses of drotrecogin alfa (activated).

Introduction: Serial alterations in protein C levels appear to correlate with disease severity in patients with severe sepsis, and it may be possible to tailor severe sepsis therapy with the use of this biomarker. The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis.

Methods: This was a phase 2 multicenter, randomized, double-blind, controlled study.

Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain.

Context: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown.

Salience modulation and associative inhibition interaction: short but not long exposure to similar stimuli protects the salience of the unique elements.

In three experiments, rats were given preexposure to two similar flavour compounds, AX and BX. Following preexposure, conditioning trials took place in which AX was paired with an illness-induced unconditioned stimulus. Animals that were given short alternated preexposure to AX and BX, showed higher generalization of conditioned aversion to AX to a new compound, AN, than animals that were given blocked preexposure (short and long) and long alternated preexposure (Experiments 1 and 2); and showed less preference for A when they were given a choice between A and X (Experiment 3).

Reasons for refusal of admission to intensive care and impact on mortality.

Purpose: To identify factors influencing triage decisions and investigate whether admission to the intensive care unit (ICU) could reduce mortality compared with treatment on the ward.

Methods: A multicentre cohort study in 11 university hospitals from seven countries, evaluating triage decisions and outcomes of patients referred for admission to ICU who were either accepted, or refused and treated on the ward. Confounding in the estimation of the effect of ICU admission on mortality was controlled by use of a propensity score approach, which adjusted for the probability of being admitted.