Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study.

Objective: To determine if intravenous thiamine would reduce lactate in patients with septic shock.

Design: Randomized, double-blind, placebo-controlled trial.

Setting: Two US hospitals.

The relationship between age and outcome in out-of-hospital cardiac arrest patients.

Aim: To determine the association between age and outcome in a large multicenter cohort of out-of-hospital cardiac arrest patients.

Methods: Retrospective, observational, cohort study of out-of-hospital cardiac arrest from the CARES registry between 2006 and 2013. Age was categorized into 5-year intervals and the association between age group and outcomes (return of spontaneous circulation (ROSC), survival and good neurological outcome) was assessed in univariable and multivariable analysis.

The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity.

Introduction: Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown.

Methods: We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010.

Disease heterogeneity and risk stratification in sepsis-related occult hypoperfusion: A retrospective cohort study.

Purpose: Occult hypoperfusion is associated with increased mortality in patients with sepsis. We sought to determine the practice patterns and outcomes of patients with sepsis-related occult hypoperfusion and introduce a potential method for risk stratification.

Materials And Methods: Single-center retrospective study of normotensive patients presenting to an urban tertiary care emergency department with lactate greater than or equal to 4 mmol/L and suspected infection.

When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.

Background: Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest.

Pyruvate Dehydrogenase Activity and Quantity Decreases After Coronary Artery Bypass Grafting: a Prospective Observational Study.

Introduction: Pyruvate dehydrogenase (PDH) is a key gatekeeper enzyme in aerobic metabolism. The main purpose of this study was to determine if PDH activity is affected by major stress in the form of coronary artery bypass grafting (CABG), which has previously been used as a model of critical illness.

Methods: We conducted a prospective, observational study of patients undergoing CABG at an urban, tertiary care hospital.

Intravenous thiamine is associated with increased oxygen consumption in critically ill patients with preserved cardiac index.

Rationale: Oxygen consumption may be impaired in critically ill patients.

Objectives: To evaluate the effect of intravenous thiamine on oxygen consumption ([Formula: see text]o2) in critically ill patients.

Methods: This was a small, exploratory open-label pilot study conducted in the intensive care units at a tertiary care medical center.

The association between a quantitative computed tomography (CT) measurement of cerebral edema and outcomes in post-cardiac arrest-a validation study.

Aim: Previous studies have examined the association between quantitative head computed tomography (CT) measures of cerebral edema and patient outcomes reporting that a calculated gray matter to white matter attenuation ratio (GWR) of <1.2 indicates a near 100% non-survivable injury post-cardiac arrest. The objective of the current study was to validate whether a GWR <1.

Initial lactate and lactate change in post-cardiac arrest: a multicenter validation study.

Objective: Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. The objective of the current study was to determine the association between percent lactate change and outcomes in post-cardiac arrest patients.

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia.

Background: Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH.

The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis.

Purpose: Thiamine functions as an important cofactor in aerobic metabolism and thiamine deficiency can contribute to lactic acidosis. Although increased rates of thiamine deficiency have been described in diabetic outpatients, this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA). In the present study, we hypothesize that thiamine deficiency is associated with elevated lactate in patients with DKA.

Sublingual microcirculation is impaired in post-cardiac arrest patients.

Aim: We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory markers in the post-cardiac arrest state.

Methods: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy.

Continuous neuromuscular blockade is associated with decreased mortality in post-cardiac arrest patients.

Aim: Neuromuscular blockade may improve outcomes in patients with acute respiratory distress syndrome. In post-cardiac arrest patients receiving therapeutic hypothermia, neuromuscular blockade is often used to prevent shivering. Our objective was to determine whether neuromuscular blockade is associated with improved outcomes after out-of-hospital cardiac arrest.

Fever after rewarming: incidence of pyrexia in postcardiac arrest patients who have undergone mild therapeutic hypothermia.

Background: Induction of mild therapeutic hypothermia (TH; temperature 32-34°C) has become standard of care in many hospitals for comatose survivors of cardiac arrest. Pyrexia, or fever, is known to be detrimental in patients with neurologic injuries such as stroke or trauma. The incidence of pyrexia in the postrewarming phase of TH is unknown.

APACHE II scoring to predict outcome in post-cardiac arrest.

Introduction: Despite advancements in management of cardiac arrest, mortality remains high and few severity of illness scoring systems have been calibrated in this population. The goal of the current investigation was to assess the Acute Physiology and Chronic Health Evaluation II score in post-cardiac arrest.

Measurements: This is a prospective observational study of adult post-cardiac arrest patients at a tertiary-care center.