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  • 1
    Electronic Resource
    Electronic Resource
    Acquired neuromuscular disorders in critically ill patients: a systematic review (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1242-1250 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critical illness ; Neuromuscular abnormalities ; Ventilator-dependence ; Sepsis ; Electromyography ; Muscle biopsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To summarize the prospective clinical studies of neuromuscular abnormalities in intensive care unit (ICU) patients. Study identification and selection: Studies were identified through MEDLINE, EMBASE, references in primary and review articles, personal files, and contact with authors. Through duplicate independent review, we selected prospective cohort studies evaluating ICU-acquired neuromuscular disorders. Data abstraction: In duplicate, independently, we abstracted key data regarding design features, the population, clinical and laboratory diagnostic tests, and clinical outcomes. Results: We identified eight studies that enrolled 242 patients. Inception cohorts varied; some were mechanically ventilated patients for ≥ 5 days, others were based on a diagnosis of sepsis, organ failure, or severe asthma while others were selected on the basis of exposure to muscle relaxants, or because of participation in muscle biochemistry studies. Weakness was systematically assessed in two of the eight studies, concerning patients with severe asthma, with a reported frequency of 36 and 70 %, respectively. Electrophysiologic and histologic abnormalities consisted of both peripheral nerve and muscle involvement and were frequently reported, even in non-selected ICU patients. In a population of patients mechanically ventilated for more than 5 days, electrophysiologic abnormalities were reported in 76 % of cases. Two studies showed a clinically important increase (5 and 9 days, respectively) in duration of mechanical ventilation and a mortality twice as high in patients with critical illness neuromuscular abnormalities, compared to those without. Conclusions: Prospective studies of ICU-acquired neuromuscular abnormalities include a small number of patients with various electrophysiologic findings but insufficiently reported clinical correlations. Evaluation of risk factors for these disorders and studies examining their contribution to weaning difficulties and long-term disability are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050757
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  • 2
    Electronic Resource
    Electronic Resource
    Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients (2000)
    Springer
    Intensive care medicine 26 (2000), S. S153 
    Details
    ISSN: 1432-1238
    Keywords: Key words Procalcitonin ; ¶C-reactive protein ; Interleukin 6 (IL-6) ; Sepsis ; Infection ; Septic shock ; Outcome ; ICU
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection in ICU medical and surgical patients.¶Setting: A 10-bed medical surgical unit.¶Design: PCT, C-reactive protein (CRP), interleukin 6 (IL-6) dosages were sampled in four groups of patients: septic shock patients (SS group), shock without infection (NSS group), patients with systemic inflammatory response syndrome related to a proven bacterial infection (infect. group) and ICU patients without shock and without bacterial infection (control group).¶Results: Sixty patients were studied (SS group: n = 16, NSS group, n = 18, infect. group, n = 16, control group, n = 10). The PCT level was higher in patients with proven bacterial infection (72 ± 153 ng/ml vs 2.9 ± 10 ng/ml, p = 0.0003). In patients with shock, PCT was higher when bacterial infection was diagnosed (89 ng/ml ± 154 vs 4.6 ng/ml ± 12, p = 0.0004). Moreover, PCT was correlated with severity (SAPS: p = 0.00005, appearance of shock: p = 0.0006) and outcome (dead: 71.3 g/ml, alive: 24.0 g/ml, p = 0.006). CRP was correlated with bacterial infection (p 〈 10–5) but neither with SAPS nor with day 28 mortality. IL-6 was correlated with neither infection nor day 28 mortality but was correlated with SAPS. Temperature and white blood cell count were unable to distinguish shocked patients with or without infection. Finally, when CRP and PCT levels were introduced simultaneously in a stepwise logistic regression model, PCT remained the unique marker of infection in patients with shock (PCT ≥ 5 ng/ml, OR: 6.2, 95 %CI: 1.1–37, p = 0.04).¶Conclusion: The increase of PCT is related to the appearance and severity of bacterial infection in ICU patients. Thus, PCT might be an interesting parameter for the diagnosis of bacterial infections in ICU patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051135
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    Paper (German National Licenses)
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