Kenelle tehohoitoa annetaan?

Teema : tehohoitolääketied

Vanhuspotilaan tehohoidon mahdollisuudet ja rajoitteet

VertaisarvioituMerkittävä osa kriittisesti sairaista vanhuksista hyötyy tehohoidosta, vaikka ennuste heikkeneekin iän ¬lisääntyessä. Toisaalta huonosti kohdennettu hoito voi lisätä kuolevan kärsimyksiä ja aiheuttaa turhia ¬kustannuksia. Suomessa viime vuosina päivystysluonteisesti tehohoitoon otetuista yli 80-vuotiaista joka neljäs menehtyi saman sairaalahoitojakson aikana ja noin puolet vuoden kuluessa. Voimakkaimmin ennusteeseen vaikuttavat edeltävä toimintakyky, akuutin sairauden vaikeusaste ja ¬pitkäaikaissairaudet. Ratkaisevaa on, onko elintoimintahäiriöihin johtanut perussyy hoidettavissa.Peer reviewe

Glucocorticoids inhibit type I IFN beta signaling and the upregulation of CD73 in human lung

Non peer reviewe

Beta-blocker treatment in the critically ill : a systematic review and meta-analysis

Background Critical illness may lead to activation of the sympathetic system. The sympathetic stimulation may be further increased by exogenous catecholamines, such as vasopressors and inotropes. Excessive adrenergic stress has been associated with organ dysfunction and higher mortality. beta-Blockers may reduce the adrenergic burden, but they may also compromise perfusion to vital organs thus worsening organ dysfunction. To assess the effect of treatment with beta-blockers in critically ill adults, we conducted a systematic review and meta-analysis of randomized controlled trials. Materials and methods We conducted a search from three major databases: Ovid Medline, the Cochrane Central Register for Controlled Trials and Scopus database. Two independent reviewers screened, selected, and assessed the included articles according to prespecified eligibility criteria. We assessed risk of bias of eligible articles according to the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen randomized controlled trials comprising 2410 critically ill patients were included in the final review. A meta-analysis of 11 trials including 2103 patients showed a significant reduction in mortality in patients treated with beta-blockers compared to control (risk ratio 0.65, 95%CI 0.53-0.79; p < .0001). There was no significant difference in mean arterial pressure or vasopressor load. Quality of life, biventricular ejection fraction, blood lactate levels, cardiac biomarkers and mitochondrial function could not be included in meta-analysis due to heterogenous reporting of outcomes. Conclusions In this systematic review we found that beta-blocker treatment reduced mortality in critical illness. Use of beta-blockers in critical illness thus appears safe after initial hemodynamic stabilization. High-quality RCT's are needed to answer the questions concerning optimal target group of patients, timing of beta-blocker treatment, choice of beta-blocker, and choice of physiological and hemodynamic parameters to target during beta-blocker treatment in critical illness. KEY MESSAGES A potential outcome benefit of beta-blocker treatment in critical illness exists according to the current review and meta-analysis. Administration of beta-blockers to resuscitated patients in the ICU seems safe in terms of hemodynamic stability and outcome, even during concomitant vasopressor administration. However, further studies, preferably large RCTs on beta-blocker treatment in the critically ill are needed to answer the questions concerning timing and choice of beta-blocker, patient selection, and optimal hemodynamic targets.Peer reviewe

NSE concentrations and haemolysis after cardiac arrest

Non peer reviewe

Premorbid functional status as a predictor of 1-year mortality and functional status in intensive care patients aged 80 years or older

We assessed the association between the premorbid functional status (PFS) and 1-year mortality and functional status of very old intensive care patients. Using a nationwide quality registry, we retrieved data on patients treated in Finnish intensive care units (ICUs) during the period May 2012aEuro'April 2013. Of 16,389 patients, 1827 (11.1%) were very old (aged 80 years or older). We defined a person with good functional status as someone independent in activities of daily living (ADL) and able to climb stairs without assistance; a person with poor functional status was defined as needing assistance for ADL or being unable to climb stairs. We adjusted for severity of illness and calculated the impact of PFS. Overall, hospital mortality was 21.3% and 1-year mortality was 38.2%. For emergency patients (73.5% of all), hospital mortality was 28% and 1-year mortality was 48%. The functional status at 1 year was comparable to the PFS in 78% of the survivors. PFS was poor for 43.3% of the patients. A poor PFS predicted an increased risk of in-hospital death, adjusted odds ratio (OR) 1.50 (95% confidence interval, 1.07-2.10), and of 1-year mortality, OR 2.18 (1.67-2.85). PFS data significantly improved the prediction of 1-year mortality. Of very old ICU patients, 62% were alive 1 year after ICU admission and 78% of the survivors had a functional status comparable to the premorbid situation. A poor PFS doubled the odds of death within a year. Knowledge of PFS improved the prediction of 1-year mortality.Peer reviewe