Abstract:
OBJECTIVE:Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus seropositive patients admitted to the ICU with acute respiratory distress syndrome has therefore been proposed. We assessed cytomegalovirus seroprevalence as a risk factor for morbidity and mortality in patients with acute respiratory distress syndrome. DESIGN:Prospective observational cohort study. We used the number of days alive and free of mechanical ventilation on day 28 as a composite outcome measure and used multivariable ordinal logistic regression analyses to adjust for potential confounders. SETTING:ICUs of two tertiary care hospitals in The Netherlands. PATIENTS:We included all newly admitted patients with acute respiratory distress syndrome who received mechanical ventilation for at least 4 days. Patients with known immunocompromise and those receiving antiviral treatment prior to ICU admission were excluded. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Over a 2-year period, 306 patients were included, 209 (68%) of whom were cytomegalovirus seropositive. Cytomegalovirus reactivation occurred in 53 of these cases (26%). One hundred patients (33%) died or continued to be mechanically ventilated by day 28. After adjustment for confounding, cytomegalovirus seroprevalence was not associated with the primary outcome (crude odds ratio, 1.09; 95% CI, 0.70-1.70; adjusted odds ratio, 1.01; 95% CI, 0.64-1.59). Seroprevalence was also not associated with poor outcome in any of the prespecified subgroup analyses. However, a significant association was found in a post hoc subgroup of patients who had developed acute respiratory distress syndrome in a setting of septic shock (adjusted odds ratio, 2.86; 95% CI, 1.32-6.23). The time course of pulmonary markers in survivors was comparable between the two serogroups. CONCLUSIONS:Cytomegalovirus seroprevalence is not associated with prolonged mechanical ventilation or increased mortality in critically ill patients with acute respiratory distress syndrome, with possible exception of patients presenting with septic shock. Therefore, a prevention strategy targeting an unselected cohort of seropositive patients with acute respiratory distress syndrome is unlikely to show any meaningful benefit.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Ong DS,Klein Klouwenberg PM,Verduyn Lunel FM,Spitoni C,Frencken JF,Dekker HA,Schultz MJ,Bonten MJ,Cremer OLdoi
10.1097/CCM.0000000000000712subject
Has Abstractpub_date
2015-02-01 00:00:00pages
394-400issue
2eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract:OBJECTIVES:The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181fa4196
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between aminoglycoside disposition kinetics and hemodynamic response to sepsis, as well as vital support therapy, in critically ill patients with sepsis. DESIGN:Cross-sectional study of critically ill patients with sepsis undergoing physiologic and aminoglycoside pharmacokinetic m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199705000-00016
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. DESIGN:A 3-yr (199...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00008
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVES:The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health reco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003302
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To compare the impact of two different customization strategies in the performance of the admission Mortality Probability Model II (MPM II0) using formal statistical assessment. DESIGN:Analysis of the database of a multicenter, multinational, prospective cohort study, EURICUS-1, involving 89 intensive care u...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199712000-00017
更新日期:1997-12-01 00:00:00
abstract:OBJECTIVE:Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care. DESIGN:Multicenter, prospective cohort study. SETTING:ICUs of 24 Canadian hospitals. PARTICI...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001024
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:To demonstrate the efficacy and safety of an updated version of the nasal "bridle," which is used to prevent the accidental removal of small-bore nasoenteric feeding tubes. DESIGN:A descriptive study. SETTING:Surgical intensive care unit in a tertiary care hospital. PATIENTS:Twenty-six critically ill patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199603000-00011
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVE:Antibiotic therapy is a major risk factor for the development of diarrhea and colitis with varying severity. Often the origin of antibiotic-associated gastrointestinal deterioration remains elusive and no specific infectious agents could be discerned. PATIENTS:We represent three cases of intractable high-vol...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002310
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:To test the short-term physiologic effects (indexes of respiratory effort, ventilation, and gas exchange), leaks, patient-ventilator asynchrony, and comfort of four noninvasive ventilation (NIV) facial, oronasal, or oral interfaces with major differences in internal volume. DESIGN:Prospective, short-term, cr...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31819b575f
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiology and pharmacokinetics of a novel hemoglobin-based oxygen carrier of bovine origin. DESIGN:Randomized, single-blind, placebo-controlled, dose-escalation study. SETTING:The Upjohn Research Clinics (Kalamazoo, MI). SUBJECTS:Normal healthy adult men between the ages of 18 and 45 yrs. ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199605000-00006
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVE:To examine the value of laser bronchoscopy in patients with inoperable carcinoma of the lung who required ventilatory assistance for acute respiratory failure. DESIGN:Retrospective review of the medical records of all patients undergoing laser bronchoscopy. SETTING:The Lahey Clinic Medical Center, a tertiar...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199303000-00016
更新日期:1993-03-01 00:00:00
abstract::Vecuronium's short half-life and minimal cardiopulmonary side-effects make it a suitable drug for continuous infusion. Vecuronium is used frequently in critically ill patients to increase their total compliance and to minimize the adverse effects of mechanical ventilation. This crossover, prospective study evaluates t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198910000-00004
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:To examine the effects of mechanical ventilation with a tidal volume of 6 mL/kg compared with 12 mL/kg predicted body weight on hemodynamics, vasopressor use, fluid balance, diuretics, sedation, and neuromuscular blockade within 48 hrs in patients with acute lung injury and acute respiratory distress syndrome...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000149836.76063.71
更新日期:2005-01-01 00:00:00
abstract::Because of the neonate's susceptibility to pulmonary hypertension (PHN) and his inefficiency in invoking the compensatory mechanisms often used by adults to maintain stable levels of O2 consumption (VO2) in the face of changes in O2 delivery (DO2) and metabolic demand, we have attempted to define the O2 handling capab...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198808000-00008
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVE:Hypoxemic reperfusion attenuates brain injury secondary to severe cerebral ischemia, myocardial, and intestinal injury occurring in intestinal postischemic shock, and offers hemodynamic stabilization and attenuation of inflammatory response when applied in the resuscitation from hemorrhagic shock. In this stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819b81ec
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not sh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000104111.61317.4B
更新日期:2004-01-01 00:00:00
abstract::Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197611000-00011
更新日期:1976-11-01 00:00:00
abstract:OBJECTIVES:Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of death and disability among children worldwide. Identifying sepsis in pediatric patients is difficult and can lead to treatment delay. Our objective was to assess the host proteomic response...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004083
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To test whether intensive care unit (ICU) nasal screening for methicillin-resistant Staphylococcus aureus (MRSA) predicts the presence or absence of MRSA infections requiring antimicrobial treatment. DESIGN:A prospective cohort study. SETTING:Medical ICU at Barnes-Jewish Hospital, a 1252-bed urban teaching ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181eeda3f
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:Several studies have suggested that intravenous hydroxyethyl starch treatment may dampen acute inflammatory responses. It is well documented that limited oxygen delivery to tissues (hypoxia) is common in acute inflammation, and numerous parallels exist between acute responses to hypoxia and to inflammation, i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000218814.77568.BC
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVES:To describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system failure. DESIGN:Rev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199406000-00023
更新日期:1994-06-01 00:00:00
abstract::Assessment of creatinine clearance (CC) in ICU patients was compared using three methods. The reference method (CC 24 h) used measurements of serum creatinine and urinary creatinine after collection of urine over a 24-h period. The other two methods were predictive methods: the Kampmann nomogram and the formula develo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199011000-00007
更新日期:1990-11-01 00:00:00
abstract:OBJECTIVE:To measure exhaled nitric oxide (NO) and compare it with lung function after cardiopulmonary bypass (CPB) in adult patients. Pulmonary dysfunction is sometimes observed after CPB. Impaired production of NO may account for this dysfunction. DESIGN:Prospective, single-center, observational study. SETTING:Univ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200012000-00012
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of sympathetic and parasympathetic nervous system activity on the heart rate and other hemodynamic variables in acute emergency patients with mild to moderately severe trauma. DESIGN:Clinical study. SETTING:Level 1 university-run trauma service. PATIENTS:Fourteen trauma patients stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000127776.78490.e4
更新日期:2004-06-01 00:00:00
abstract::Seven dogs with electromagnetic flow probes implanted on their main (QT) and left (QL) pulmonary arteries, had catheters placed in their left atria and pulmonary artery, and were ventilated via Carlen's double-lumen endotracheal tubes. The effect of high-frequency oscillation (HFO) on the redistribution of pulmonary b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198405000-00008
更新日期:1984-05-01 00:00:00
abstract::An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As pla...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198702000-00016
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002053
更新日期:2017-02-01 00:00:00
abstract::The conjunctival oxygen monitor reflects oxygen tension of the internal carotid artery without introducing the heating artifact characteristic of transcutaneous monitors. It is now being used in the ICU and the operating room to measure accurately and continuously Po2 and temperature of conjunctival tissue. We examine...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198508000-00016
更新日期:1985-08-01 00:00:00
abstract:BACKGROUND AND METHODS:In the present study, we evaluated the effect of N-acetylcysteine treatment in a nonseptic shock model induced by zymosan in the rat. Animals were randomly divided into eight groups (ten animals in each group). The first group was treated with ip administration of saline solution (0.90% NaCl) and...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199908000-00021
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:Despite concern over the appropriateness and quality of care provided in an intensive care unit (ICU) at the end of life, the number of Americans who receive ICU care at the end of life is unknown. We sought to describe the use of ICU care at the end of life in the United States using hospital discharge data ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114816.62331.08
更新日期:2004-03-01 00:00:00