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Severity of illness scores are increasingly used in the intensive care environment to help predict outcome, to characterize disease severity and degree of organ dysfunction, to stratify patients for clinical trial enrollment, to assess resource use, and to compare intensive care unit (ICU) performance. This article reviews the most commonly used severity of illness scoring systems and discusses some of their uses and limitations. [ABSTRACT FROM AUTHOR]

Abstract Introduction  Excessive use of adrenergic agents may result in stunned myocardium. Cases  We report the cases of two patients with subarachnoid hemorrhage (SAH) complicated by cardiogenic shock secondary to triple-H therapy for cerebral vasospasm. Both patients had normal cardiac function on admission and no signs of acute myocardial infarction at the onset of cardiogenic shock. Intra-aortic balloon pump (IABP) counterpulsation was used to maintain adequate cerebral perfusion while enabling the high doses of norepinephrine that were being administered to be reduced. Reversal of the myocardial dysfunction after vasopressors were discontinued supported a diagnosis of catecholamine-induced stunned myocardium. Conclusion  IABP counterpulsation may be one therapeutic option for patients with vasospasm after SAH when high doses of vasopressors can induce severe myocardial dysfunction. However, this invasive device may not be sufficient to maintain adequate cerebral perfusion and fatal embolic events can complicate the clinical course. [ABSTRACT FROM AUTHOR]

Abstract??The autopsy has long been regarded as an important tool for clinical confrontation, education and quality assurance. The aims of this study were to examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU) and to identify the types of errors in diagnosis to improve quality of care. Autopsies from 289 patients who died in the ICU during a 2-year period were studied. Post-mortem examination revealed unexpected findings in 61 patients (21%) including malignancy, pulmonary embolism, aspergillosis, myocardial or mesenteric infarction and unsuspected bacterial, viral or fungal infection. These unexpected findings were classified as Goldman class I errors in 17 (6%), class II in 38 (13%) and class III in six (2%) cases. Although the incidence of unexpected findings with clinical significance was low, post-mortem examination remains a valuable source of pertinent information that may improve the management of ICU patients. [ABSTRACT FROM AUTHOR]

The article summarizes the current understanding of the fundamental immune alterations in critical illness that lead to organ failure in the intensive care unit (ICU). It discusses the classes of pattern recognition receptors (PRR) within the human innate immune response that contribute in alerting the host to microbial invasion or tissue damage. It tackles the scope of the problem with organ failure in critical illness. Also addressed is the role of lymphocyte populations in critical illness.