Subject(s)
Acinetobacter Infections/microbiology , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/pharmacology , Colistin/pharmacology , Drug Resistance, Multiple, Bacterial , Drug Synergism , Thienamycins/pharmacology , Acinetobacter baumannii/isolation & purification , Humans , Intensive Care Units , Meropenem , Microbial Sensitivity TestsABSTRACT
This study explores the role of procalcitonin (PCT) in predicting the outcome of sepsis. In a prospective multicentre observational investigation, blood was sampled within 24 h of onset of sepsis in 1156 hospitalised patients; 234 were in the intensive care unit (ICU) at the point of presentation of sepsis while 922 were not. PCT was estimated in serum by the ultrasensitive Kryptor assay in a double-blinded fashion. Among patients outside the ICU, mortality was 8% in those with PCT ≤0.12 ng/mL but 19.9% in those with PCT >0.12 ng/mL [P<0.0001, odds ratio (OR) for death: 2.606; 95% confidence interval (CI): 1.553-4.371]. Among patients whose sepsis presented in ICU, mortality was 25.6% in those with PCT ≤0.85 ng/mL but 45.3% in those with PCT >0.85 ng/mL (P=0.002; OR for death: 2.404; 95% CI: 1.385-4.171). It is concluded that PCT cut-off concentrations can contribute to predicting the outcome of sepsis and might be of particular value in identifying patients who would benefit from ICU admission.
Subject(s)
Calcitonin/blood , Clinical Laboratory Techniques/methods , Protein Precursors/blood , Sepsis/diagnosis , Sepsis/mortality , Adult , Aged , Aged, 80 and over , Calcitonin Gene-Related Peptide , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Treatment OutcomeSubject(s)
Anesthetics, Intravenous/adverse effects , Myoglobin/metabolism , Propofol/adverse effects , Adult , Anesthetics, Intravenous/administration & dosage , Chlorine/adverse effects , Critical Illness , Humans , Male , Near Drowning , Propofol/administration & dosage , Rhabdomyolysis/chemically inducedABSTRACT
The purpose of the present study was to assess the mechanical behavior of the respiratory system separately during inspiration and expiration in adult respiratory distress syndrome (ARDS) and the influence of PEEP on any phasic variations ofthe mechanical respiratory parameters. Airways pressure (P), flow (V), and volume (V) signals were recorded in nine patients with ARDS and 10 patients without known respiratory disorder (control group). All patients were artificially ventilated at three levels of positive end-expiratory pressure (PEEP): 0, 5, and 10 hPa. Data were analyzed separately for inspiratory and expiratory records using multiple linear regression analysis (MLRA) according to the equation: P=Ers V+Rrs V'+P0, where Ers and Rrs represent, respectively, the intubated respiratory system elastance and resistance, and P0 the end-expiratory pressure. In the ARDS group expiratory Ers (ErsEXP=45.58 +/- 4.24 hPa/L) was substantially higher (p<0.01) than inspiratory Ers (ErsINSP=36.76 +/- 2.55) with a marked effect of applied PEEP in diminishing the difference between ErsEXP and ErsINSP (p<0.01). For the ARDS group inspiratory Rrs (RrsINSP) decreased significantly with increasing PEEP (PEEP=0: RrsINSP=16.43, PEEP=10: RrsINSP=13.28, p<0.01). The found differences between ErsEXP and ErsINSP could be attributable to an influence of mechanical ventilation by positive airway pressure on pulmonary edemaand interstitial fluid during the inspiratory phase of the respiratory cycle.
