Jean Louis Vincent

..CONCLUSIONS: Despite its strong vasopressor effects vasopressin infusion did not worsen microcirculatory alterations in this patient with distributive shock following cardiac surgery...

..In this clinically relevant model of septic shock due to peritonitis, vasopressin administration (alone or with norepinephrine) can prolong survival...

..Sepsis and multiple organ failure are common complications in intensive care unit (ICU) patients and are associated with considerable morbidity and mortality...

..Some biomarkers may also be useful for prognosis and guiding therapy. Here, the authors will review our changing approaches to sepsis diagnosis and discuss some of the markers that seem most relevant at the present time...

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..The timing of administration of potential therapies also needs to be taken more into consideration...

..Therapeutic hypothermia is largely used to protect the brain following return of spontaneous circulation (ROSC) after cardiac arrest (CA), but it is unclear whether we should start therapeutic hypothermia earlier, that is, before ROSC...

..Adequate and continued training are required to ensure that PAC-derived data are correctly interpreted and applied...

..Patients with ARDS are now older and more severely ill. Sepsis-related ARDS is more frequent whereas trauma-related and/or transfusion-related ARDS has decreased. MOF still represents the most frequent cause of death...

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..This narrative review provides a descriptive overview of the clinical value of this biomarker in the diagnosis, prognosis and therapeutic guidance of sepsis...

..In this text, we will return to the basic physiology of cardiac output and its components so that we can better understand the effects of cardiovascular alterations in critically ill patients, and how best to treat them...

..The aim of this study was to assess the effects of increasing MAP using norepinephrine (NE) on hemodynamic and metabolic variables and on microvascular reactivity in patients with septic shock...

..In the present commentary, we reflect on how we can move forward in the management of severely bleeding trauma patients in the current environment...

..Rigorously designed pharmacoeconomic studies are needed to delineate the costs and benefits of various approaches to fluid management...

..We studied whether these recommendations met optimal pharmacokinetic criteria for broad-spectrum antibiotic levels in septic shock patients undergoing CRRT...

..The intent of this study was to determine whether serum procalcitonin (PCT) levels are associated with prognosis, measured as organ dysfunctions and 28-day mortality, in patients with severe pneumonia...

..The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis...

..In this article, I will provide arguments why, although the two actions are indeed ethically equivalent, withdrawing life-sustaining therapy may in fact be preferable to withholding...

..Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy...

..The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements...

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..Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes...

..The aim of this study was to assess the characteristics of critically ill cancer patients, and to evaluate their prognosis...

..Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes...

..The primary aim of this study was to determine whether 25 mg/kg (total body weight) of amikacin is an adequate loading dose for these patients...

..The aim of our study was to determine whether the first dose of piperacillin-tazobactam, ceftazidime, cefepime, and meropenem would result in adequate serum drug concentrations in patients with severe sepsis and septic shock...

..We used the Sepsis Occurrence in Acutely ill Patients (SOAP) database to investigate differences in the impact of respiratory tract and abdominal sites of infection on organ failure and survival...

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..Cerebral microcirculatory alterations may play a role; however, experimental data are scarce. This study sought to investigate whether the cerebral microcirculation is altered in a clinically relevant animal model of septic shock...

..Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome...

..Little information is available on the precise role of alterations of iron metabolism in the development of iron anaemia in critically ill patients...

..In the future, new markers of renal dysfunction may facilitate treatment choices...

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..To assess the current role of selenium supplementation in critically ill patients...

..The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs)...

..The revised guidelines are far from perfect, but they represent the best available synthesis of contemporary knowledge in this area and as such should be promoted...

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..This review will discuss current definitions of sepsis, describe new approaches to classification and diagnosis of patients with sepsis, present recommendations for management, and briefly highlight areas of ongoing and future research...

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..To clarify the role of the pulmonary artery catheter in the intensive care unit...

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..All these scoring systems will need to be updated with time as ICU populations change and new diagnostic, therapeutic and prognostic techniques become available...

..We then look at the process of care and realize that, here, huge progress has been made. Lastly, we suggest how critical care medicine will continue to evolve for the better over the next 30 years...

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..In this article, we will discuss the limitations of randomized controlled trials in the intensive care unit population and highlight the importance of considering other study designs in the challenging intensive care unit environment...

..To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion...

..We will then briefly summarize the limited evidence to support use of one fluid type over another, and provide general suggestions for fluid use in these patients...

..We will review current approaches to each of these categories...

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..This was a planned substudy from the European observational Sepsis Occurrence in Acutely ill Patients (SOAP) study to investigate the possible impact of insulin-treated diabetes on morbidity and mortality in ICU patients...

..This article reviews the most commonly used severity of illness scoring systems and discusses some of their uses and limitations...

..In this article we will discuss the good, the bad, and the potentially ugly side of international clinical trials in intensive care...

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..To evaluate the safety and efficacy of active site inactivated recombinant factor VIIa (FFR-rFVIIa) in patients with acute respiratory distress syndrome...

..Observational studies have provided conflicting results regarding the effects of these two drugs on outcomes, and results from a recently completed randomized controlled trial are eagerly waited...

..Albumin may be useful in some patients, especially those with hypoalbuminaemia at risk of complications or those with liver insufficiency. Further studies are needed to clarify what precise role albumin has in today's ICU...

..We present ten reasons why we believe this approach is not appropriate and may even be detrimental...

..We used data from a large, multicenter observational study to assess whether late-onset ARDS was similarly associated with worse outcomes compared with early-onset ARDS...

..Management, therefore, relies on limiting its short- and long-term effects. One method by which this may be achieved is to reduce sedative use and promote early mobilization and exercise...

..Emphasis is placed on the importance of personalizing blood transfusion according to physiological endpoints rather than arbitrary thresholds...

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..A more accurate estimate may be possible during a period such as 1998-2000, when awareness regarding albumin safety was heightened by publication of a meta-analysis...

..To describe the risk factors for the development of and mortality resulting from acute respiratory failure (ARF) in a large patient population...

..Although associated with an increased risk of bleeding, this is usually procedure-related rather than spontaneous. Although costly, this is a drug that effectively reduces mortality rates in patients with severe sepsis...

..Anemia is a common problem in critically ill patients admitted to intensive care units (ICUs), but the consequences of anemia on morbidity and mortality in the critically ill is poorly defined...

..Systems, such as PIRO, that can characterize patients according to their likely prognosis and response to a specific therapy need to be further developed so that treatments can be appropriately directed for individual patients...

..Here, we will outline the limitations and advances of EBM in intensive care medicine, by discussing the key findings in the last few years from studies of therapeutic agents for ICU patients...

..To assess morbidity in patients with severe sepsis managed with and without drotrecogin alfa (activated)...

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..The aim of this review is to summarize recent developments in the epidemiology, diagnosis and management of infection in critically ill patients...

..Here we will discuss the current situation across Europe, based on the findings from three large international studies...

..To evaluate platelet function in sepsis...

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..To evaluate the safety and efficacy of the platelet-activating factor receptor antagonist BB-882 in the treatment of patients with sepsis...

..This article discusses the evidence for and against a key role for disseminated intravascular coagulation in the pathogenesis of multiple organ failure...

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..Experimental models can make an important contribution in gathering such evidence. Rigorous pharmacoeconomic studies are also needed to define the benefits and costs of differing fluid regimens...

..Because coagulopathy is associated with high mortality rates, and animal studies have indicated that therapeutic intervention may result in improved outcomes, it was rational to initiate clinical studies...

..The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case...

..In this review we will discuss the epidemiology of ARF within the limitations imposed by comparing studies that use different definitions and focus on different patient populations...

..The combination of dobutamine with norepinephrine was associated with a better myocardial performance, greater Do(2) and [OV0312]o(2), lower blood lactate concentration and Pco(2) gap, and less anatomic injury...

..v. fluid did not affect outcome...

..4 [46.6-64.9] vs. 79.3 [67.2-83.2]%; p =.02). CONCLUSIONS: Microcirculatory alterations improve rapidly in septic shock survivors but not in patients dying with multiple organ failure, regardless of whether shock has resolved...

..The objective of this study was to develop a model to identify patients in whom drotrecogin alfa (activated) (DAA) might be administered for periods shorter than the recommended 96 hours...

..We explored a possible association between TNF-alpha, interleukin (IL)-6, IL-10, transforming growth factor (TGF)-beta, and interferon (IFN)-gamma cytokine polymorphisms, their in vivo production, and mortality from cardiogenic shock...

..In endotoxic shock, GLP is increased, but the liver can metabolize this additional load of lactate, so that the hepatosplanchnic area is not a major source of lactate unless the liver becomes profoundly hypoxic...

..The optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock...