Abstract:
OBJECTIVE:To determine whether extreme obesity (morbid obesity; body mass index > or =40 kg/m(2)) is an independent risk factor for death among critically ill patients; this objective is most salient in the subset of patients who sustain a prolonged intensive care unit stay during which the burdens of care imposed by obesity and its consequences would become most apparent. DESIGN:Cohort analysis of data from the Project Impact database used to catalog admissions and outcomes to a surgical intensive care unit, with predetermined end point analyses of outcomes. SETTING:Surgical intensive care unit serving Tufts-New England Medical Center, a tertiary care and university medical center in Boston. PATIENTS:All critically ill surgical patients admitted to the Tufts-New England Medical Center surgical intensive care unit from January 1998 to March 2001. INTERVENTIONS:Intensive care unit and hospital mortality and lengths of stay were compared with body mass index subclassified into five groups: underweight, normal weight, overweight, obese, and extremely obese. Data were examined for all admissions during the study period and for a predetermined subgroup with a prolonged intensive care unit stay (> or =4 days). MEASUREMENTS AND MAIN RESULTS:The prevalence of obesity in the surgical intensive care unit was 26.7%; extreme obesity was observed in 6.8%. In the full cohort of patients (n = 1373), median length of stay was short (2 days) and there were no differences in mortality in patients among any of the body mass index classes. In the subgroup of prolonged stay patients (n = 406), intensive care unit and hospital mortality rates were significantly increased in extremely obese patients compared with all other patients (intensive care unit, 33.3% vs. 12.3%, p = .009; hospital, 33.3% vs. 16%, p = .045). Multivariate analysis showed that extreme obesity was an independent predictor of death in surgical critically ill patients with prolonged intensive care unit stay after controlling for age, gender, and severity of illness. The odds of death increased 7.4 times in patients with morbid obesity. CONCLUSIONS:Morbid obesity (body mass index > or =40 kg/m(2)) is an independent risk factor for death in surgical patients with catastrophic illness requiring prolonged intensive care. The prevalence of obesity is growing, both in the intensive care unit and in the general population. The increased risk of complications and death in this population mandates that we adapt customized processes of care to specifically address this unique and very challenging subset of patients.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Nasraway SA Jr,Albert M,Donnelly AM,Ruthazer R,Shikora SA,Saltzman Edoi
10.1097/01.CCM.0000205758.18891.70subject
Has Abstractpub_date
2006-04-01 00:00:00pages
964-70; quiz 971issue
4eissn
0090-3493issn
1530-0293journal_volume
34pub_type
评论,杂志文章abstract:OBJECTIVE:To determine whether a cellular phone would interfere with the operation of mechanical ventilators. DESIGN:Laboratory study. SETTING:University medical center. SUBJECTS:Fourteen mechanical ventilators. INTERVENTIONS:We evaluated change in operation and malfunction of the mechanical ventilators. MEASUREME...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000120061.01431.db
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVE:To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures. DESIGN:Prospective study. SETTING:Heart surgery intensive care ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000084807.15352.93
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:To quantify glucose balance related to continuous arteriovenous hemofiltration (CAVH) when a glucose-rich replacement fluid is used for the plasma ultrafiltrate removed. DESIGN:Prospective, nonintervention study. SETTING:Medical/surgical and cardiac surgical intensive care units of a university hospital. P...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199308000-00014
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVE:Sepsis-induced multi-organ failure continues to have a high mortality. The liver is an organ central to the disease pathogenesis. The objective of this study was to identify the liver proteins that change in abundance with sepsis and subsequently identify new drug targets. DESIGN:Proteomic discovery study an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000281858.44387.a2
更新日期:2007-10-01 00:00:00
abstract::An 8-yr-old child suffered traumatic bilateral pneumothoraces and a ruptured right main bronchus. Surgical repair of the bronchus was postponed for 18 h after a definite diagnosis was established due to severe hypoxemia and hypercarbia. Only left endobronchial high-frequency ventilation with muscle relaxation correcte...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00019
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181a03063
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To determine the financial impact of a sepsis protocol designed for use in the emergency department. DESIGN:Retrospective analysis of a before-after study testing the implications of sepsis protocol. SETTING:Academic, tertiary care hospital in the United States. PATIENTS:Persons with septic shock presentin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000261886.65063.CC
更新日期:2007-05-01 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
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198109000-00005
更新日期:1981-09-01 00:00:00
abstract::Human hemoglobin (Hb) solution is being developed for use as an oxygen-delivering resuscitation fluid. Substantial improvements in the general purity and quality of experimental Hb solutions have been achieved by recent research efforts. Hb solutions now appear to be free of the undesirable biological effects that wer...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198204000-00002
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVE:Our goal was to demonstrate explicitly that lower-frequency positive-pressure ventilation not only preserves adequate oxygenation and acid-base status in hemorrhagic states, but also that "normal" or higher respiratory rates significantly compromise hemodynamics, even with moderate degrees of hemorrhage. DES...
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pub_type: 杂志文章
doi:10.1097/01.ccm.0000134264.88332.37
更新日期:2004-09-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199507000-00011
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:To review the incidence, diagnosis, and management of septic emboli caused by vascular catheters after surgery for congenital heart disease. DESIGN:Retrospective clinical review. All patients were computer registered. Our database includes daily follow-up and every sign of infection registered. SETTING:Pedi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200003000-00039
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To determine whether a continuous intravenous infusion of pentoxifylline, a methylxanthine derivative, alters the serum cytokine concentrations and/or hemodynamic measurements in patients with septic shock. DESIGN:A prospective, randomized, double-blind, placebo-controlled study. SETTING:Medical intensive c...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199602000-00005
更新日期:1996-02-01 00:00:00
abstract::The hemodynamic effects of digitalis were examined in ten patients with acute cardiac failure. Administration of 10 micrograms/kg of digoxin iv resulted in significant increases in cardiac index, stroke volume index, and left ventricular stroke work index within one hour in five patients with acute myocardial infarcti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198711000-00002
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVES:To review the immunologic role of the cytokines and the specific role that tumor necrosis factor (TNF) plays in response to infection. The influence of bacterial lipopolysaccharide on TNF, the cytokine cascade, and resultant pathologies are also reviewed. DATA SOURCES:A MEDLINE search of the international E...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVES:To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients. DESIGN:Analysis of International Nutrition Survey database col...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004712
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:To review the institutional experience of a national tertiary referral center for extracorporeal life support (ECLS) in severe varicella pneumonia. DATA SOURCES:Hospital records and ECLS flow sheets. STUDY SELECTION:All pediatric (nonneonatal) and adult patients who were treated for varicella pneumonia with...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199706000-00014
更新日期:1997-06-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. DESIGN:A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. SETTING:Heart Institute of São Paulo University. PATIENTS:High-ri...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000003185
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVES:Fever is common and associated with increased mortality among patients admitted to adult ICUs, yet recent literature suggests that the incidence of fever may be decreasing. The objective of this study was to determine whether the incidence of fever in adult ICUs changed over time and the factors responsible ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828a43b2
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:Recent in vivo studies of both septic humans and animals demonstrate that leukocyte delivery is attenuated to sites remote from the primary infection. The mechanisms for this are not entirely clear. L-selectin is integral to rolling, the first step in leukocyte recruitment to an inflammatory site. L-selectin ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200101000-00024
更新日期:2001-01-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003083
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:Severe thermal injury causes immune dysfunctions involving both pro- and anti-inflammatory mechanisms. It subsequently leads to a state of immune deficiency that shares some similarities with sepsis-induced immunosuppression. A hallmark of the latter is established by decreased monocyte human leukocyte antige...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000275271.77350.B6
更新日期:2007-08-01 00:00:00
abstract::Given the multiple biological, metabolic, and pharmacologic effects of supplemental arginine, much effort has been devoted to defining its role in numerous clinical conditions. Herein, we review the multiple pathways of arginine metabolism with its various enzyme systems; the effect of arginine on nutrition, healing, ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000279188.97421.FE
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVE:Sepsis is life-threatening organ dysfunction due to dysregulated host responses to infection. Current knowledge of human B-cell alterations in sepsis is sparse. We tested the hypothesis that B-cell loss in sepsis involves distinct subpopulations of B cells and investigated mechanisms of B-cell depletion. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002380
更新日期:2017-05-01 00:00:00
abstract::We report a case of an amniotic fluid embolism (AFE) causing a cardiorespiratory arrest associated temporally with ingestion of castor oil in a full-term normal pregnancy. Risk factors usually associated with AFE were not found in this patient. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00016
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:To develop practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. PARTICIPANTS:A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened fr...
journal_title:Critical care medicine
pub_type: 指南,杂志文章,实务指引,评审
doi:10.1097/00003246-199802000-00046
更新日期:1998-02-01 00:00:00
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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:OBJECTIVE:The Sequential Organ Failure Assessment (SOFA) score was developed to quantify the severity of patients' illness, based on the degree of organ dysfunction. This study aimed to evaluate the accuracy and the reliability of SOFA scoring. DESIGN:Prospective study. SETTING:Adult intensive care unit (ICU) in a te...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000178178.02574.ab
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:To investigate the role of regulatory T cells in the modulation of long-term immune dysfunction during experimental sepsis. It is well established that sepsis predisposes to development of a pronounced immunosuppression. Nevertheless, the mechanisms underlying the immune dysfunction after sepsis are still not...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181e78ad0
更新日期:2010-08-01 00:00:00