Intensive care medicine
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Intensive care medicine · Sep 1996
Randomized Controlled Trial Clinical TrialN-acetylcysteine pretreatment of cardiac surgery patients influences plasma neutrophil elastase and neutrophil influx in bronchoalveolar lavage fluid.
Study of leukocyte activation and release of toxic mediators during extracorporeal circulation (ECC). ECC can be used to study the potential protective effect of a pharmacon against neutrophil-mediated lung injury. Clinical studies have indicated that N-acetylcysteine (NAC) may improve systemic oxygenation and reduce the need for ventilatory support when given to patients with acute lung injury. ⋯ Pretreatment with NAC may prevent lung injury by diminishing elastase activity. Since the release of mediators, especially MPO, is not affected, this diminished activity of elastase may be achieved by enhanced inactivation by antiproteases after initial treatment.
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Intensive care medicine · Sep 1996
Randomized Controlled Trial Clinical TrialPostextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone.
To evaluate the risk factors for postextubation laryngeal stridor and its prevention by hydrocortisone in adult patients. ⋯ Hydrocortisone did not significantly reduce the incidence of postextubation laryngeal edema or stridor. From the risk factors evaluated, we were unable to demonstrate a statistical correlation between postextubation stidor and the duration of the intubation, the patient's age, the internal diameter of the endotracheal tube, or the route of intubation. However, female patients were more likely to develop this complication.
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Intensive care medicine · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe infusion requirements and recovery characteristics of cisatracurium or atracurium in intensive care patients.
To investigate the infusion requirements and recovery characteristics of cisatracurium compared with atracurium when both are administered by prolonged continuous infusion. ⋯ Cisatracurium provides a satisfactory level of neuromuscular blockade in adult ICU patients at approximately one-third the infusion rate of atracurium and with a similar recovery time.
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Intensive care medicine · Jul 1996
Randomized Controlled Trial Clinical Trial Retracted PublicationDoes long-term continuous administration of pentoxifylline affect platelet function in the critically ill patient?
The methylxanthine derivative pentoxifylline (PTX) is one of those promising substances which are under current investigation to modify or limit inflammatory response. Anti-aggregation activity has also been described that may contribute to the beneficial effects of this substance. Long-term effects on platelet function have not been elucidated yet. ⋯ Continuous infusion of PTX for 5 days did not impair platelet function in critically ill patients. In both trauma and sepsis patients, the usual deterioration in platelet function was even attenuated, which may be due to the effects of PTX on cytokine release (e.g., reduction in tumor necrosis factor and interleukin-1), improvement in microcirculation, or additional fibrinolytic effects.
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Intensive care medicine · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialClinical evaluation of diminished early expiratory flow (DEEF) ventilation in mechanically ventilated COPD patients.
To evaluate the cardiopulmonary effects, especially the end-expiratory lung volume (EEV) and ventilation inhomogeneity during diminished early expiratory flow ventilation (DEEF), which resembles pursed-lips breathing, with the conventional intermittent positive pressure ventilation (IPPV) in postoperative mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). ⋯ There was no improvement in pulmonary and hemodynamic parameters during the DEEF mode in comparison to the IPPV mode. The small increase in EEV during DEEF was probably caused by the slightly higher mean expiratory pressures as in the PEEP mode. However, this had no effect on the hemodynamic parameters. As we could not observe any improvement with the DEEF ventilation in our optimally pretreated postoperative COPD patients, we do not advise applying this therapy in this group of patients, since this mode of ventilation may cause barotrauma if not monitored adequately.