Rescue therapy in septic shock--is terlipressin the last frontier?

Use of terlipressin, an analogue of vasopressin, can be considered in septic shock patients with intractable hypotension and high cardiac output in whom fluid resuscitation and high-dose conventional catecholamines have failed. The effects of this agent on organ function are poorly evaluated in humans. The limited number of patients evaluated precludes any analysis of adverse outcomes and prognosis.

Clinical review: Vasopressin and terlipressin in septic shock patients.

Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of septic shock. Terlipressin (tricyl-lysine-vasopressin) is the synthetic, long-acting analogue of vasopressin, and has comparable pharmacodynamic but different pharmacokinetic properties. Vasopressin mediates vasoconstriction via V1 receptor activation on vascular smooth muscle.

The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients.

In patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.

Renal effects of norepinephrine in septic and nonseptic patients.

Objective: To assess the effects of a norepinephrine-induced vasoconstriction on renal function in septic and nonseptic patients.

Design: Open-label prospective study.

Setting: Medical-surgical ICU in an urban teaching hospital.

Cell adhesion molecules as a marker reflecting the reduction of endothelial activation induced by glucocorticoids.

In vitro, steroids down-regulate the expression of cell adhesion molecules (CAMs) in endothelial cells stimulated by lipopolysaccharide. Low-dose hydrocortisone is a new treatment of patients with septic shock, a state that is characterized by an endothelial injury. The aim of the present study was to investigate whether the plasma levels of soluble CAMs, reflecting in vivo endothelial activation, could be modulated in patients with septic shock treated by hydrocortisone.

Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards.

The aim of this study was to compare the distribution of Candida species in patients hospitalized in an intensive care unit (ICU) and in conventional wards. A retrospective analysis was performed covering an 18-year period in a 700-bed teaching hospital. Various body sites were investigated in all patients admitted during the study and isolates were identified by microscopic and macroscopic morphology, and by commercially available kits.

Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year.

Objective: To assess the effect on outcome (1 yr) of decompressive craniectomy performed within or after the first 24 hrs post-trauma in severely head-injured trauma patients with intractable cerebral hypertension.

Design: Retrospective cohort study.

Settings: Intensive care unit of a university hospital.

Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients.

Objective: To determine whether selective digestive decontamination (SDD) had some negative impact on the bacterial resistance observed in strains isolated from samples from patients receiving nonabsorbable antibiotics and cefazolin.

Design: Case-control study.

Setting: Intensive care unit of a university tertiary-care hospital.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

Objective: To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU).

Design And Setting: Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital.

Interventions: Prospective patient surveillance of patients included in two successive studies of two urine drainage systems.

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

Objective: In a previous non-randomized study, we demonstrated that no difference occurred in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in patients in an intensive care unit (ICU). To confirm this result, we performed a randomized, prospective, and powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients.

Design: Randomized, prospective, and controlled study.

Comparison of effectiveness of two urinary drainage systems in intensive care unit: a prospective, randomized clinical trial.

Objective: In a previous nonrandomized study we observed no difference in the rate of acquisition of bacteriuria between a complex closed drainage system (CCDS) and a two-chamber drainage system (TCDS) in ICU patients. To confirm this result we performed a statistically powerful study assessing the effectiveness of the CCDS and the TCDS in ICU patients.

Design And Setting: Randomized, prospective, and controlled study in the medicosurgical intensive care unit (16 beds) in a teaching hospital.

Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome.

Objective: To assess the adequacy of empirical antimicrobial therapy prescribed in septic shock patients and to evaluate the relationship between inadequate antimicrobial therapy and 30-day mortality.

Design: Prospective observational study.

Setting: Medical-surgical (16-bed) intensive care unit in an urban teaching hospital.

Brain tissue penetration of ciprofloxacin following a single intravenous dose.

Ciprofloxacin distribution was assessed in cerebral tissues in 14 patients undergoing craniotomy. The study objective was to determine the brain tissue/serum concentration ratio of ciprofloxacin. Patients received a single intravenous (iv) 200 mg dose of ciprofloxacin.

Influence on outcome of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selected digestive decontamination.

Objective: Ventilator-associated pneumonia is said to be associated with an increased mortality or a prolonged intensive care unit stay. In multiple trauma, the use of selective digestive decontamination has been reported to decrease morbidity and mortality associated with pneumonia. We performed a study to evaluate the attributable morbidity and mortality of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selective digestive decontamination.

Role of glycopeptides in the treatment of septic complications after cardiac surgery.

Agents like Staphylococcus epidermidis and Staphylococcus aureus are common agents in both early and late prosthetic valve endocarditis (PVE). Streptococci, especially vividans and enterococci are more apt to occur late. Diphtheroids and gram-negative bacteria are also frequent in early and late PVE.

The combination of a heat and moisture exchanger and a Booster: a clinical and bacteriological evaluation over 96 h.

Objective: To determine whether the combination with a new device (Booster ) for active humidification improves the efficacy of a hydrophobic heat and moisture exchanger (HME).

Design And Setting: Prospective, interventional study in the ICU of a university hospital.

Patients: Consecutive patients requiring controlled mechanical ventilation

Interventions: Patients were ventilated with a HME, and a Booster was added for 96 h to the ventilatory circuit.

Randomized clinical trial of extended use of a hydrophobic condenser humidifier: 1 vs. 7 days.

Objective: To determine whether extended use (7 days) would affect the efficiency on heat and water preservation of a hydrophobic condenser humidifier as well as the rate of ventilation-acquired pneumonia, compared with 1 day of use.

Design: Prospective, controlled, randomized, not blinded, clinical study.

Setting: Twelve-bed intensive care unit of a university hospital.

Prevention of nosocomial urinary tract infection in ICU patients: comparison of effectiveness of two urinary drainage systems.

Study Objectives: To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients.

Design: Prospective, nonrandomized, controlled trial.

Setting: Medical/surgical/trauma ICU in a university hospital.

Long-term arterial cannulation in ICU patients using the radial artery or dorsalis pedis artery.

Study Objectives: To evaluate the rate of arterial thrombosis and catheter-related infection following radial artery or dorsalis pedis artery (DPA) cannulations lasting > or = 4 days.

Design: Prospective, observational study of two cohorts of ICU patients.

Setting: ICU of a university hospital.

Measurement of tracheal temperature is not a reliable index of total respiratory heat loss in mechanically ventilated patients.

Background: Minimizing total respiratory heat loss is an important goal during mechanical ventilation. The aim of the present study was to evaluate whether changes in tracheal temperature (a clinical parameter that is easy to measure) are reliable indices of total respiratory heat loss in mechanically ventilated patients.

Method: Total respiratory heat loss was measured, with three different methods of inspired gas conditioning, in 10 sedated patients.

Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation.

Objective: The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed.

Design: Prospective cohort observational study.

High adenosine plasma concentration as a prognostic index for outcome in patients with septic shock.

Objective: Sepsis and septic shock are a common cause of mortality in critically ill patients. Many substances have been implicated in the pathophysiology of these syndromes. We postulated that adenosine may be implicated in the sepsis- or septic shock-induced blood pressure failure.

Effect of norepinephrine on the outcome of septic shock.

Objective: Despite increasingly sophisticated critical care, the mortality of septic shock remains elevated. Accordingly, care remains supportive. Volume resuscitation combined with vasopressor support remains the standard of care as adjuvant therapy, and many consider dopamine to be the pressor of choice.

Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein.

Objective: To determine the frequency of central venous catheter-induced thrombosis of the axillary vein.

Design: Prospective, controlled study.

Setting: Tertiary care university center.