Abstract:
OBJECTIVE AND DESIGN:To review and discuss selected literature, expert opinion, and conventional care of the hyperglycemic perioperative or critically ill patient. MAIN POINTS:Diabetes mellitus, the most commonly encountered perioperative endocrinopathy, continues to increase dramatically in prevalence. Diabetes is the sixth most common cause of death in the United States and significantly affects other more common causes of death such as cardiac disease and stroke. Diabetic patients commonly have microvascular and macrovascular pathology that influences their perioperative course and critical illness and increases morbidity and mortality rates during hospitalization. Since diabetics require more surgeries and receive critical care more frequently than their nondiabetic counterparts, preemptive identification and anticipation of diabetic complications and comorbidities, along with an optimized treatment plan, are the foundation for the proper intensive care of this growing patient population. Hyperglycemia occurs commonly in critically ill diabetic patients but also is frequent in those who have a history of normal glucose homeostasis. The new onset of hyperglycemia in critically ill patients is driven by excessive counterregulatory stress hormone release and high tissue and circulating concentrations of inflammatory cytokines. Aggressive glycemic management improves short- and long-term outcomes in diabetic patients with acute myocardial infarction and cardiac surgical patients. Most recently, "tight" glycemic control in both diabetic and nondiabetic hyperglycemic intensive care unit patients resulted in improved survival in selected surgical patients without excessive consequences related to hypoglycemia. The mechanisms of benefit of euglycemia appear to be multifactorial. CONCLUSIONS:Up to 25% of patients admitted to the intensive care unit have previously diagnosed diabetes. Diabetics are most commonly admitted for treatment of complications of comorbid diseases. New-onset hyperglycemia also is common in critically ill patients, and it affects patient morbidity and mortality rates. A growing body of literature supports the benefits of tight glycemic control in certain patient populations. However, further data are needed about the optimal concentration of blood glucose, the role of maintaining euglycemia in a broader group of patients (including the medically critically ill), and the mechanisms of benefit of infused glucose and insulin.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Coursin DB,Connery LE,Ketzler JTdoi
10.1097/01.ccm.0000115623.52021.c0subject
Has Abstractpub_date
2004-04-01 00:00:00pages
S116-25issue
4 Suppleissn
0090-3493issn
1530-0293pii
00003246-200404001-00006journal_volume
32pub_type
杂志文章,评审abstract:OBJECTIVES:Extracorporeal cardiopulmonary resuscitation has shown survival benefit in select patients with refractory cardiac arrest but there is insufficient data on the frequency of different types of brain injury. We aimed to systematically review the prevalence, predictors of and survival from neurologic complicati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004377
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:To investigate a role of the opiate system during acute hypoxic hypoxia, the effects of naloxone and morphine on hypoxic survival rate were investigated in awake adult mice. DESIGN:Prospective, randomized, animal trial. SETTING:University research laboratory. SUBJECTS:Male dd-Y mice (n = 864 in experiment ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00035
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVES:To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel Nati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746736
更新日期:2013-03-01 00:00:00
abstract::The effects of PEEP and subsequent augmentation of cardiac output by sodium nitroprusside (SNP) were examined in a canine model of asymmetric oleic acid injury to the right lung. PEEP (9.2 +/- 0.5 cm H2O) was added to six animals to decrease venous admixture (Qsp/Qt) from 50.6 +/- 4.4% to 16.0 +/- 1.3% (p less than .0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198903000-00008
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To review trial design issues related to control groups. DESIGN:Review of the literature with specific reference to critical care trials. MAIN RESULTS AND CONCLUSIONS:Performing randomized controlled trials in the critical care setting presents specific problems: studies include patients with rapidly lethal...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181922bf4
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was to characterize pulmonary surfactant properties in children undergoing cardiovascular surgery with cardiopulmonary bypass. DESIGN:Prospective clinical trial. SETTING:University hospital pediatric intensive care unit. PATIENTS:Fifty pediatric patients with congenital cardiac...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200301000-00045
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:Less than half of the thousands of children who suffer in-hospital cardiac arrests annually survive, and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation improves short-term survival, but its impact on longer term survival and mitochondrial respiration-a potenti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003620
更新日期:2019-03-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199810000-00028
更新日期:1998-10-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0000000000000224
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:Sepsis is associated with a marked depression of cellular immune function. The steroid hormone dehydroepiandrosterone (DHEA) is proposed to have immunoenhancing activities. We, therefore, investigated the effect of DHEA on the mortality rate and cellular immune functions in an experimental model of sepsis. D...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200102000-00029
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Subcutaneously administered low-molecular-weight heparins are widely used for prevention of venous thromboembolism. The appropriateness of the subcutaneous route in critically ill patients has never been established. OBJECTIVE:To determine anti-Xa activities in critically ill patients and in noncritically i...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000059725.60509.A0
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001164
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:The acute respiratory distress syndrome may complicate postpartum hemorrhagic shock and resuscitation, but its mechanisms are not yet well defined. We studied the lung inflammatory response to postpartum hemorrhagic shock and resuscitation in a rabbit model and the role of the nuclear factor-κB pathway. DESI...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182451c17
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:Trauma induces a state of immunosuppression, which is responsible for the development of nosocomial infections. Hydrocortisone reduces the rate of pneumonia in patients with trauma. Because alterations of dendritic cells and natural killer cells play a central role in trauma-induced immunosuppression, we inve...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000000658
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVES:Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. DESIGN:A...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31828a4337
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVES:To review the intensive care unit experience of patients with admitted or acquired nosocomial endocarditis (NE) defined according to the Duke criteria. DESIGN:Prospective, cohort study. SETTING:University teaching hospital. PATIENTS:We reviewed the records of 22 patients documented with NE during a 6-yr p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200002000-00015
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00028
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVES:Increases in exhaled nitric oxide have been demonstrated to originate from the lungs of rats after septic lung injury. The aim of this study was to investigate whether treatment with the nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME) would prevent lipopolysaccharide (LPS)-induced in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199802000-00033
更新日期:1998-02-01 00:00:00
abstract::We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were posit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To estimate the prevalence of, the risk factors associated with, and the outcome of tracheostomy in a heterogeneous population of mechanically ventilated patients. DESIGN:Prospective, observational cohort study. SETTING:A total of 361 intensive care units from 12 countries. PATIENTS:A cohort of 5,081 patie...
journal_title:Critical care medicine
pub_type: 评论,杂志文章,多中心研究
doi:10.1097/01.ccm.0000150026.85210.13
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients wi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199512000-00006
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVE:Procalcitonin, the precursor peptide of calcitonin, has been shown to be a serum marker of the severity and mortality of several systemic inflammatory response syndromes. This study addressed the correlation of serum procalcitonin with the course of classic (nonexertional) heatstroke. DESIGN:Serum samples we...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199708000-00024
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVES:To test whether hospital-based physicians made different intensive care unit and life-sustaining treatment decisions for otherwise identical black and white patients with end-stage cancer and life-threatening hypoxia. DESIGN:We conducted a randomized trial of the relationship between patient race and physic...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3182186e98
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety and physiologic actions of ibuprofen in patients with severe sepsis. DESIGN:Randomized, double-blind, placebo-controlled trial. SETTING:Three university hospital medical ICUs. PATIENTS:Twenty-nine patients with clinical evidence of sepsis and the need for hemodynamic monitoring with ...
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:10.1097/00003246-199111000-00006
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVES:This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subar...
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:10.1097/00003246-199506000-00004
更新日期:1995-06-01 00:00:00
abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181eb3ccd
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVES:To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN:Quasi-experimental, before-after trial. SETTING:Emergency department and ICUs of an academic cente...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002268
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVES:To validate scoring algorithm criteria established by the Japanese Association for Acute Medicine (JAAM) for disseminated intravascular coagulation (DIC) and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, from the Japanese Ministry of Health and Welfare (JMHW) and I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000202209.42491.38
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVE:Nondepolarizing neuromuscular blocking agents are commonly used in the intensive care setting, but they have occasionally been associated with development of myopathy. In addition, diaphragmatic atrophy and a reduction in diaphragmatic force were reported after short-term controlled mechanical ventilation in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000245783.28478.AD
更新日期:2006-12-01 00:00:00