Intensive care medicine
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Intensive care medicine · Jul 2002
ReviewClinical implications of antibiotic-induced endotoxin release in septic shock.
Antibiotic-induced release of bacterial cell wall components can have immediate adverse effects for the patient. This article reviews the data on endotoxin release after initiation of antibiotic therapy and its role in the pathogenesis of sepsis and septic shock. ⋯ Antibiotics that induce the formation of long, aberrant bacterial cells before effectively killing the microorganisms show the highest degree of endotoxin liberation. There is increasing evidence from animal models and clinical studies of sepsis that the antibiotic-mediated release of biologically active cell wall components derived from Gram-positive, Gram-negative or fungal organisms is associated with a rapid clinical deterioration.
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Intensive care medicine · Jul 2002
Comparative StudyQuality of life after intensive care--evaluation with EQ-5D questionnaire.
To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU). ⋯ Intensive care unit variables (e.g., diagnosis, length of stay and severity of disease) and patient's background data (e.g., age, gender, education, main activity, smoking habits, experience with serious illness and previous health status) may be significant determinants of HR-QOL. However, when adjusted for background data, most ICU variables are no longer associated with EQ-5D. This should cause attention to be paid to the role of a patient's background in the evaluation of HR-QOL and to a careful interpretation of EQ-5D results when comparing ICUs.
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Intensive care medicine · Jul 2002
Comparative StudyInfluences on physicians' choices of intravenous colloids.
Controversy over the optimal intravenous fluid for volume resuscitation continues unabated. Our objectives were to characterize the demographics of physicians who prescribe intravenous colloids and determine factors that enter into their decision to choose a colloid. ⋯ The majority of physicians surveyed prescribe colloid products and the reported use of albumin and pentastarch has a bimodal distribution. Although albumin appeared to be preferred in more clinical niches, most physicians did not state reasons for choosing between products. Marketing, specialty, location of practice and clinical scenario appear to play significant roles in the utilization of colloid products.
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To determine the magnitude of the treatment effect of low-dose dopamine on renal function in patients at risk of and in patients with early renal injury. ⋯ The results of this meta-analysis confirms that low-dose dopamine has no reno-protective effect. Considering the potential side-effects of dopamine this agent should not be used for this indication.