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Marcus J Schultz

Publications and source records attributed to Marcus J Schultz.

At least 37 records · Page 2Linked to original sources
PubMed2006

Evaluation of short-term consequences of hypoglycemia in an intensive care unit.

BACKGROUND: Introduction of strict glycemic control has increased the risk for hypoglycemia in the intensive care unit. Little is known about the consequences of hypoglycemia in this setting. We examined short-term consequences (seizures, coma, and death) of hypoglycemia in the intensive care unit. PATIENTS AND METHODS: All occurrences of hypoglycemia (glucose of <45 mg/dL) in our intensive care unit between September 1, 2002, and September 1, 2004, were identified. Patients with hypoglycemia (n = 156) were matched for time to hypoglycemia with control patients drawn from the at-risk population (nested case control method). Seizures observed within 8 hrs after hypoglycemia were scored. Discharge summaries for cases and controls were reviewed for occurrence of possible hypoglycemia-associated coma and death. A hazard ratio for in-hospital death was calculated with Cox regression analysis. RESULTS: The hazard ratio for in-hospital death was 1.03 (95% confidence interval, 0.68-1.56; p = .88) in patients with a first occurrence of hypoglycemia relative to the controls without hypoglycemia, corrected for duration of intensive care unit admittance before hypoglycemia, age, sex, and Acute Physiology and Chronic Health Evaluation II score at admission. No cases of hypoglycemia-associated death were reported. Hypoglycemic coma was reported in two patients. Seizures after hypoglycemia were observed in one patient. CONCLUSIONS: In this study, no association between incidental hypoglycemia and mortality was found. However, this data set is too small to definitely exclude the possibility that hypoglycemia is associated with intensive care unit mortality. In three patients with possible hypoglycemia-associated coma or seizures, a causal role for hypoglycemia seemed likely but could not fully be established.

Adult↗
PubMed2006

Contrast media inhibit exogenous surfactant therapy in rats with acute respiratory distress syndrome.

AIM: To test the effects of various contrast media on the pulmonary surfactant system. MATERIAL AND METHODS: In a rat model of acute respiratory distress syndrome (ARDS) induced by lung lavage, the effects of surfactant suspended in saline were compared with surfactant suspended in the contrast media Visipaque, Gastrografin, Omnipaque, Telebrix M, Telebrix and Hexabrix, to establish their influence on oxygenation and lung mechanics. RESULTS: After the induction of ARDS, surfactant instillation improved oxygenation, total lung capacity (TLC(35)), volume at 5 cm H(2)O end-expiration (V(5)) and Gruenwald index. The effects of Visipaque and Gastrografin were comparable with those of surfactant alone from 90 min onwards and at 120 min, respectively. Surfactant suspended in the other contrast media resulted in significantly lower values in the above-mentioned parameters. Surface tension was lowest in surfactant suspended in saline alone. Surfactant suspended in Visipaque and Gastrografin had lower surface tension compared with surfactant suspended in the other contrast media. CONCLUSION: The ionic and non-ionic contrast media used in this study, cause an impairment of the physico-chemical behaviour of exogenous surfactant. Therefore, these contrast media cannot be regarded as safe in case of accidental exposure.

Animals↗
PubMed2006

Cystatin C in critically ill patients treated with continuous venovenous hemofiltration.

Assessment of residual renal function in critically ill patients with acute renal failure (ARF) treated with continuous venovenous hemofiltration (CVVH) is difficult. Cystatin C (CysC) is a low-molecular-weight protein (13.3 kDa) removed from the body by glomerular filtration. Its serum concentration has been advocated for assessment of renal function in patients with kidney disease. To investigate whether the removal of CysC by CVVH is likely to influence its serum concentration, concentrations of CysC were measured in 3 consecutive samples in 18 patients with oliguric ARF treated with CVVH (2 L/hr). Samples were taken from the afferent and efferent blood lines and from the ultrafiltrate line. Concentrations of CysC did not change during the time interval studied. The mean serum concentrations of CysC were 2.25+/-0.45 mg/L in the afferent and 2.19+/-0.56 mg/L in the efferent samples (NS); ultrafiltrate concentrations of CysC were 1.01+/-0.45 mg/L. The sieving coefficient of CysC was 0.52+/-0.20; the clearance of CysC was 17.3+/-6.6 mL/min; and the quantity of CysC removed averaged 2.13 mg/hr. During CVVH (2 L/hr), the quantity of CysC removed is less than 30% of its production and no rapid changes in its serum concentration are observed. Therefore, CVVH (2 L/hr) is unlikely to influence serum concentrations of CysC significantly, which suggests that it can be used to monitor residual renal function during CVVH.

Acute Kidney Injury↗
PubMed2006

The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low.

INTRODUCTION: The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients. METHOD: This was a prospective observational study conducted in a 28-bed, mixed medical-surgical ICU of a university hospital. RESULTS: Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care. CONCLUSION: In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.

APACHE↗
PubMed2006

Tracheotomy does not affect reducing sedation requirements of patients in intensive care--a retrospective study.

INTRODUCTION: Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. METHODS: We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. RESULTS: Of 1,788 patients admitted to our intensive care unit during the study period, 129 (7%) were tracheotomized. After the exclusion of patients who received a tracheotomy before or at the day of admittance, 117 patients were left for analysis. The daily dose (DD; the amount of sedatives for each day) divided by the mean daily dose (MDD; the mean amount of sedatives per day for the study period) in the week before and the week after tracheotomy was 1.07 +/- 0.93 DD/MDD versus 0.30 +/- 0.65 for morphine, 0.84 +/- 1.03 versus 0.11 +/- 0.46 for midazolam, and 0.62 +/- 1.05 versus 0.15 +/- 0.45 for propofol (p < 0.01). However, when we focused on a shorter time interval (two days before and after tracheotomy), there were no differences in prescribed doses of morphine and midazolam. Studying the course in DD/MDD from seven days before the placement of tracheotomy, we found a significant decline in dosage. From day -7 to day -1, morphine dosage (DD/MDD) declined by 3.34 (95% confidence interval -1.61 to -6.24), midazolam dosage by 2.95 (-1.49 to -5.29) and propofol dosage by 1.05 (-0.41 to -2.01). After tracheotomy, no further decrease in DD/MDD was observed and the dosage remained stable for all sedatives. Patients in the non-surgical and acute surgical groups received higher dosages of midazolam than patients in the elective surgical group. Time until tracheotomy did not influence sedation requirements. In addition, there was no significant difference in sedation between different patient groups. CONCLUSION: In our intensive care unit, sedation requirements were not further reduced after tracheotomy. Sedation requirements were already sharply declining before tracheotomy was performed.

Aged↗
PubMed2006

N-acetylcysteine and other preventive measures for contrast-induced nephropathy in the intensive care unit.

The increase in diagnostic imaging procedures that require infusion of intravenous radiographic contrast has led to a parallel increase in the incidence of contrast-induced nephropathy (CIN). Since CIN accounts for a significant increase of hospital-acquired renal failure, length of stay and mortality, several additive strategies to prevent CIN are presently advocated, including N-acetylcysteine (NAC), sodium bicarbonate, theophylline or fenoldopam, and peri-procedural hemofiltration/hemodialysis. As only one (non-randomized) study has been performed in the intensive care setting, at present it is hard to give firm recommendations on preventive measures for CIN in intensive care patients. Indeed, future studies are needed to determine the true role of the above-mentioned preventive measures in critically ill patients at risk for CIN. Since NAC has only few side-effects, we presently advise NAC as an additive preventive measure in the intensive care setting. Theophylline or sodium bicarbonate hydration are viable options, either in conjunction NAC or as alternatives.

Acetylcysteine↗
PubMed2006

Pulmonary coagulopathy as a new target in therapeutic studies of acute lung injury or pneumonia--a review.

OBJECTIVES: To review the involvement of coagulation and fibrinolysis in the pathogenesis of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), pulmonary infection, and ventilator-induced lung injury (VILI). DATA SOURCE: Published articles on experimental and clinical studies of coagulation and fibrinolysis in ALI/ARDS, pneumonia, and mechanical ventilation. CONCLUSIONS: Alveolar fibrin deposition is an important feature of ALI/ARDS and pulmonary infection. The mechanisms that contribute to disturbed alveolar fibrin turnover are localized tissue factor-mediated thrombin generation and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. These effects on pulmonary coagulation and fibrinolysis are regulated by various proinflammatory cytokines and are similar to those found in the intravascular spaces during severe systemic inflammation. Some studies also suggest that pulmonary coagulopathy is a feature of VILI. Recent studies have demonstrated the beneficial effect of anticoagulant therapy in sepsis. Theoretical considerations suggest that this anticoagulant therapy will benefit patients with primary lung pathology including VILI, but clinical studies are needed to examine this hypothesis before such therapy is to be advocated as a standard of care in critically ill patients.

Blood Coagulation Disorders↗
PubMed2006

Time to wean after tracheotomy differs among subgroups of critically ill patients: retrospective analysis in a mixed medical/surgical intensive care unit.

OBJECTIVE: To determine the time to wean from mechanical ventilation and time spent off the ventilator per day after tracheotomy in critically ill patients in a 28-bed mixed medical and surgical intensive care unit (ICU) in Amsterdam, Netherlands. METHODS: We conducted a retrospective analysis of consecutive patients during the 14-month period from November 1, 2003, through January 1, 2005. Included were translaryngeally intubated mechanically ventilated patients who received a tracheotomy during their ICU stay. RESULTS: Of all the patients admitted to the ICU, 129 (7%) received a tracheotomy. Significantly more tracheotomies were performed in neurosurgery/neurology patients and in those admitted for acute conditions (16% and 12%, respectively). Tracheotomy was performed a median 8 days (interquartile range 4-13 d) after ICU admission. For all the patients, the median time to wean after tracheotomy was 5 days (interquartile range 2-11 d). Neurosurgery/neurology patients and patients in the cardiology subgroup needed significantly less time to wean from mechanical ventilation than did patients in other subgroups (3 d, interquartile range 2-7 d, and 3 d, interquartile range 2-5 d, respectively, p < 0.05). There was a significant association between admission group and neurological status at the time of tracheotomy. A low Glasgow coma scale score was associated with shorter time to wean. Within 1 week after tracheotomy, the probability of the patient having breathed spontaneously, without ventilator assistance, for > 4 h/d was 89%, 78% for > 8 h/d, and 72% for > 12 h/d. By day 28, the probability of the patient having breathed spontaneously for > 4 h/d was 98%, 97% for > 8 h/d, and 94% for > 12 h/d. CONCLUSION: Time to wean from after tracheotomy differed among the subgroups in our ICU. After tracheotomy, the majority of patients were quickly able to breathe spontaneously without assistance of the mechanical ventilator for several hours per day. Patients who require tracheotomy only for airway protection wean sooner than other patients.

Aged↗
PubMed2005

Case report of a smuggler's dinner: carrots and asparagus, or bolitas?

BACKGROUND: Body packing is a distinct method of drug smuggling. Surgeons and intensive care specialists will be confronted with body packers when packets do not pass spontaneously and rupture, causing drug toxicity. CASE REPORT: We report of a 32-year-old Liberian male who presented with abdominal complaints and anxiety after having ingested 50 cocaine-containing packets of which 49 had passed the natural route in the previous days. X-ray of his abdomen showed a structure possibly compatible with a packet in or projected over the stomach. We decided to transfer the patient to the operation theatre for surgical removal via gastrotomy. However, no packet was found. During his first day in the intensive care unit he did not regain consciousness. Repeated urine analyses for cocaine were negative. After one day he deteriorated: he needed circulatory support because of hypotension, without signs of sepsis. Repeated surgery revealed no packet. In the end he turned out not to be suffering from cocaine intoxication. CONCLUSIONS: When confronted with a case of body packing in which packets do not pass spontaneously and produce bowel obstruction or in which badly wrapped packets rupture, causing drug toxicity, it is of utmost importance to establish the nature of the packet's content.

Adult↗
PubMed2005

Serial changes in soluble triggering receptor expressed on myeloid cells in the lung during development of ventilator-associated pneumonia.

OBJECTIVE: To determine the diagnostic role of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in non-directed bronchial lavage fluid in ventilator-associated pneumonia (VAP). DESIGN: Non-directed bronchial lavage fluid and plasma were collected on alternate days in critically ill mechanically ventilated patients from the start of ventilatory support until complete weaning from the ventilator. Soluble TREM-1 levels were measured by an enzyme-linked immunosorbent assay. SETTING: A general adult medical and surgical university hospital intensive care unit. PATIENTS: Nine patients who developed VAP and 19 patients who did not develop VAP (controls). RESULTS: Plasma levels of sTREM-1 did not change significantly in either patient group. While in controls concentrations of sTREM-1 in non-directed bronchial lavage fluid did not change significantly over time, in patients who developed VAP levels of sTREM-1 in non-directed bronchial lavage fluid increased towards the diagnosis of VAP. A cut-off value for non-directed bronchial lavage fluid sTREM-1 levels of 200 pg/ml on the day of VAP had a diagnostic sensitivity of 75% and a specificity of 84%. Sensitivity increased when taking into account all sTREM-1 levels higher than 200 pg/ml from the 6-day period before the day of diagnosis that were preceded by an increase of at least 100 pg/ml (sensitivity 88%, specificity 84%). CONCLUSIONS: Soluble TREM-1 is a potential biomarker of VAP.

APACHE↗