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- Dahlberg, Sofia, et al.
(författare)
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Vitamin K deficiency in critical ill patients; a prospective observational study
- 2019
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Ingår i: Journal of Critical Care. - : Elsevier BV. - 1557-8615 .- 0883-9441. ; 49, s. 105-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as “protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)”, has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality. Methods: Ninety-five patients admitted to the ICU had blood samples taken near admission and every third day. In addition to PIVKA-II and PT-INR, critical-care severity scores were computed. Results: The median baseline PIVKA-II was 4.97 μg/L compared to the upper reference of 2.0 μg/L. PIVKA-II further increased at days 3 and 6, (median 7.88 μg/L, p = .047 and median 8.14 μg/L, p = .011) predominantly in cardiac arrest patients (median 21.4 μg/L, day 3). Conclusion: Intensive care patients have increased PIVKA-II levels at admission, which increases during the ICU stay, especially in cardiac arrest patients. There were no correlations between PIVKA-II and PT-INR, SOFA score or mortality. Further studies are needed to determine why PIVKA-II increases and whether high PIVKA-II levels in ICU patients affect long-term mortality or morbidity. Previous article in issue
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- Gogniat, Emiliano, et al.
(författare)
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Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients
- 2018
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Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 45, s. 231-238
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS).Material and methods: Fourteen ARDS patients under lung protective ventilation settingswere submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH(2)O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step.Results: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (Delta P.(15%), n = 7, p = .016) and those in which the change was <= 15% (Delta P-<= 15%, n = 7, p = .700). VDBohr/VT was higher in Delta P-<= 15% than in Delta P-<= 15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) p = .018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) p = .012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) p = .008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) p = .006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) p =. 001]. We found a good correlation between Delta P and VDBohr/VT only in the Delta P.(15%) group (r = 0.74, p < .001).Conclusions: Increases in PEEP result in higher VDBohr/VT only when associated with an increase in driving pressure.
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- Jonsson, Niklas, et al.
(författare)
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Performance of plasma measurement of neutrophil gelatinase-associated lipocalin as a biomarker of bacterial infections in the intensive care unit
- 2019
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Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 53, s. 264-270
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To assess the value of dimeric neutrophil-gelatinase associated lipocalin (NGAL) as an early marker of bacterial infection and its response to antibiotic therapy in intensive care unit (ICU) patients.Materials & methods: We measured daily plasma dNGAL in 198 patients admitted to a mixed ICU. Likelihood of infection was determined with International Sepsis Forum criteria. Wemeasured dNGAL in 145 healthy controls to establish normal values.Results: ICU patients had higher dNGAL than healthy controls. A suspected or confirmed infection was independently associated with 90% (95% CI 15-215%) higher dNGAL than absence of infection. We observed no association between acute kidney injury and dNGAL. Diagnostic accuracy at antibiotic treatment initiation, assessed with area under the receiver-operating characteristics curve (AUC-ROC), for dNGAL was 0.70 (95% CI 0.60-0.79). AUC-ROC for dNGAL 24 h before antibiotic treatment initiation was 0.54 (95% CI 0.41-0.66). The mean (95% CI) change of dNGAL in the first 2 days after appropriate antibiotic therapy initiation was -31 (-49,-13)%.Conclusions: In our cohort of ICU patients, plasma dNGAL was associated with presence of bacterial infections independent of AKI but it performed poor as a predictor of infections. Following antibiotic therapy, dNGAL markedly decreased-supporting further exploration of dNGAL-guided antibiotic de-escalation.
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