Cerebral autoregulation is influenced by carbon dioxide levels in patients with septic shock.

Background: Altered brain perfusion may play an important role in the development of sepsis-associated encephalopathy. However, whether or not cerebral autoregulation (CA) is preserved in such condition has been debated. CA is dependent on cerebral vascular tone, the main determinant of which is the concentration of carbon dioxide (CO2).

Initial and delayed onset of acute respiratory failure: factors associated with development and outcome.

In a prospective observational study of 1038 adult admissions to a 31-bed medical/surgical intensive care unit (ICU), acute respiratory failure (ARF, defined as a Pao(2)/Fio(2) ratio 48 h after ICU admission) in 49 (16%). On admission, the cardiovascular sequential organ failure assessment (SOFA) score was higher in initial than in delayed onset ARF (1.

Serum levels of C-reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver.

Concentrations of C-reactive protein (CRP) and procalcitonin (PCT) have been suggested as markers of infection. The liver is believed to be a key source of CRP and PCT. For this reason we assessed the predictive value of these markers in patients with hepatic cirrhosis in a 31-bed university-hospital department of intensive care.

Ventriculostomy-related infections in critically ill patients: a 6-year experience.

Object: The authors undertook a study to analyze the risk factors for ventriculostomy-related infections (VRIs) in critically ill patients and their relation with outcome.

Methods: Demographic, clinical, laboratory, and microbiological data were collected from all 638 consecutive adult patients in whom an external ventriculostomy catheter was placed for monitoring during a 6-year period; patients were treated in a 31-bed intensive care unit (ICU) of a teaching hospital. Of 3726 cerebrospinal fluid (CSF) culture samples analyzed, 1348 (217 patients) showed bacterial growth; of these 97 (obtained in 58 patients [9%]) were considered to represent an infection, 106 (in 68 patients [11%]) colonization, and 145 (in 91 patients [14%]) contamination.

Quantitative TaqMan PCR for detection of Pneumocystis jiroveci.

We developed a quantitative real-time PCR assay for detection and quantification of Pneumocystis jiroveci in bronchoalveolar lavage (BAL) specimens based on primers and probe targeting the gene encoding beta-tubulin. The assay was able to detect 50 DNA copies per ml of a standard plasmid containing the target sequence. The intra- and interassay coefficients of variation were 0.

Body temperature alterations in the critically ill.

Objective: To determine the incidence of body temperature (BT) alterations in critically ill patients, and their relationship with infection and outcome.

Design: Prospective, observational study. SETTING.

Gut mucosal and plasma concentrations of glutamine: a comparison between two enriched enteral feeding solutions in critically ill patients.

Background: Addition of glutamine to enteral nutrition formulas is consistently associated with a significant decrease in septic morbidity in critically ill patients, possibly related to the attenuation of gut dysfunction. This pilot study was undertaken to compare the effects of enteral administration of two glutamine-enriched formulas containing either additional free glutamine or glutamine-rich proteins, with a standard solution on plasma and mucosal concentrations of glutamine in patients admitted in the Department of Intensive Care.

Methods: Following randomization, glutamine concentration was determined in endoscopically sampled duodenal biopsies and plasma, before and after a 7-day period of continuous administration of the designated solution.

Infection Probability Score (IPS): A method to help assess the probability of infection in critically ill patients.

Objective: To develop a simple score to help assess the presence or absence of infection in critically ill patients using routinely available variables.

Design: Observational study of a prospective cohort of patients divided into a developmental set (n = 353) and a validation set (n = 140).

Setting: Department of intensive care at an academic tertiary care center.

Are infections due to resistant pathogens associated with a worse outcome in critically ill patients?

Objectives: To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance.

Methods: All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed a nosocomial infection were prospectively followed until discharge or death.

Results: Of 949 consecutive patients admitted, 186 developed a nosocomial infection: 79 with an antimicrobial-resistant pathogen and 107 with susceptible strains.

Long-term outcome in ICU patients: what about quality of life?

Objective: Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge.

Design: Prospective, observational study.

Setting: Mixed, 31-bed, medico-surgical ICU.

C-reactive protein levels correlate with mortality and organ failure in critically ill patients.

Study Objectives: C-reactive protein (CRP) is an acute-phase protein, the blood levels of which increase rapidly in response to infection, trauma, ischemia, burns, and other inflammatory conditions. Although used frequently in the ICU as a sepsis marker, the relation of CRP levels to organ damage is not well known. This study assessed the association between early serum CRP concentrations and the development of organ failure and mortality in ICU patients.

Time course of hemoglobin concentrations in nonbleeding intensive care unit patients.

Objectives: To evaluate the time course of hemoglobin concentrations in nonbleeding intensive care unit patients.

Design: Prospective, observational study.

Setting: Multidisciplinary (medicosurgical) department of intensive care.

The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction.

Objective: To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU).

Design: Prospective, observational study.

Setting: Thirty-one-bed, university hospital ICU.

Anemia and blood transfusion in critically ill patients.

Context: Anemia is a common problem in critically ill patients admitted to intensive care units (ICUs), but the consequences of anemia on morbidity and mortality in the critically ill is poorly defined.

Objectives: To prospectively define the incidence of anemia and use of red blood cell (RBC) transfusions in critically ill patients and to explore the potential benefits and risks associated with transfusion in the ICU.

Design: Prospective observational study conducted November 1999, with 2 components: a blood sampling study and an anemia and blood transfusion study.