Journal of critical care
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Journal of critical care · Sep 1996
High-dose furosemide alters gas exchange in a model of acute lung injury.
Furosemide is often used to reduce edema in patients with acute respiratory distress syndrome (ARDS). It was hypothesized that furosemide would reduce lung water and improve gas exchange in a phorbol-myristate acetate (PMA) model of acute lung injury. ⋯ In this model of ARDS, which results in the absence of effective kidney function and multiple organ failure, furosemide compromises alveolar-capillary gas exchange and fails to influence the time course of lung water accumulation. The results suggest that the nondiuretic affects of furosemide cannot explain its purported clinical utility in ARDS.
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Journal of critical care · Jun 1996
ReviewOrgan-specific therapy in critical illness: interfacing molecular mechanisms with physiological interventions.
Sepsis and SIRS is the outward manifestation of a generalized uncontrolled inflammatory response, which, if sustained, induces widespread endothelial damage and MODS. Immunomodulating therapies, at present, have proven ineffective in reducing morbidity and mortality, presumably because of the heterogeneous nature of sepsis and septic shock and the reciprocating and redundant nature of this inflammatory cascade. Organ-specific therapies can support life but impair both organ-specific function and remote organ function. Novel therapies aimed at minimizing further organ dysfunction may improve outcome in a cost-effective fashion by preventing both further primary organ dysfunction or remote organ dysfunction secondary to the subsequent activation of the inflammatory response.
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Journal of critical care · Jun 1996
ReviewApplications of molecular biology and biotechnology: antibody therapy of sepsis.
The use of antibody therapy for the treatment of infections and inflammatory disease is well established. Unfortunately, clinical studies of antiendotoxin and anti-TNF monoclonal antibodies have failed to show clear physiological or survival benefit. ⋯ Although both monoclonal and polyclonal antibodies have the potential to protect septic humans, at this time it is the polyclonal antibodies that have shown the greatest promise. Each type of antibody possesses specific advantages and limitations, the ultimate effectiveness of which will need to be proven in large randomized clinical trials.
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Journal of critical care · Jun 1996
Dynamic right and left ventricular interactions in the rabbit: simultaneous measurement of ventricular pressure-volume loops.
This study was performed to characterize the dynamic factors determining ventricular interdependence in an open-pericardium intact animal model. ⋯ Ventricular interdependence has both systolic and diastolic components that have differing directional effects. In the pericardectomized rabbit, increases in RV ED volume decrease LV ED volume by decreasing LV diastolic compliance, but do not alter LV systolic function. Whereas, increases in LV ED volume decrease RV ES volume resulting in an increase in RV maximal elastance, but minimally alter RV diastolic function.
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Journal of critical care · Jun 1996
Effects of continuous positive airway pressure on cardiac output and plasma norepinephrine in sedated pigs.
Continuous positive airway pressure (CPAP) increases cardiac output (CO) in congestive heart failure (CHF). In six sedated pigs that were normovolemic (NV) and hypervolemic (HV), and seven previously instrumented pigs with pacing-induced CHF, we tested the hypothesis that this is associated with decreased total body sympathetic nerve activity (SNA). Hemodynamic variables and plasma norepinephrine level measurements were measured at baseline, CPAP 5 and 10 cm H2O, and recovery. ⋯ However, PNE decreased with CPAP in HV, and increased with CPAP in CHF. Increased CO was always associated with decreased systemic vascular resistance. We conclude the following: (1) increased CO with CPAP can be associated with either increasing or decreasing SNA; (2) CPAP can produce increases in CO when the heart is distended whether baseline LV function is relatively normal (HV) or depressed (CHF); and (3) there are probably a number of different mechanism increasing CO with CPAP and these may vary from condition to condition.